Eligibility
Some data that suggest both morbid obesity [Davies et. al. Anaesthesia 56: 1090, 2001] and obstructive sleep apnea [Sabers et. al. Anesth Analg 96: 1328, 2003] are not predictors of re-admission or delayed discharge from ambulatory anesthesia. ASA III (and possibly IV [Barash]) should not be excluded if their diseases are under control [Ansell et. al. Br J Anaesth 92: 71, 2004]. Length of surgery is not a criteria as there is little if any relationship between duration of surgery and recovery [Barash]. Note that any preterm infant with post-gestational age < 50 weeks should not be discharged for at least 23 hours because of the risk of apnea
University of Virginia Policies and Considerations
UVa no longer has a 350 lb limit, however keep in mind that emergency intubation equipment is limited and there are no ventilators other than in the OR (ie anyone with a prolonged anesthetic must remain in the OR)
Consensus Statement
(from [Anesthesiology 104: 1081, 2006])
Procedures That May Be Safely Performed on an Outpatient Basis for Patients with OSA
| Type of Surgery/Anesthesia | Opinion |
|---|---|
| Superficial surgery/local or regional anesthesia | Agree |
| Superficial surgery/general anesthesia | Equivocal |
| Airway surgery (adult, e.g., uvulopalatopharyngoplasty) | Disagree |
| Tonsillectomy in children less than 3 years old | Disagree |
| Tonsillectomy in children greater than 3 years old | Equivocal |
| Minor orthopedic surgery/local or regional anesthesia | Agree |
| Minor orthopedic surgery/general anesthesia | Equivocal |
| Gynecologic laparoscopy | Equivocal |
| Laparoscopic surgery, upper abdomen Disagree Lithotripsy | Agree |
