[Ambulant Anesthesia: Limits and Possibilities]. / Ambulante Anästhesie: Grenzen und Möglichkeiten.

The number of operations carried out on an outpatient basis is increasing in Germany. This trend has been observed for years. The prerequisite is an infrastructure that is in line with guidelines. The competence of the anesthetist must not be restricted to that of a standard specialist anesthetist, but the physician should have experience in ambulatory anesthesia. Well-adjusted comorbidities of the patient are generally not a contraindication for an outpatient procedure. The heavily overweight patient can also be operated on an outpatient basis if he is compliant, comorbidities are well adjusted and intensive postoperative care is ensured. Obstructive sleep apnea syndrome is per se not a contraindication for carrying out a surgical intervention on an outpatient basis. The intensive postoperative care and the presence of a CPAP device are also important in the recovery room. An important decision criterion in cardiac patients is the determination of the metabolic equivalent (MET). A MET value > 4 is considered sufficient for outpatient procedures. Postoperatively, the patient can be discharged home when the surgeon and the anesthetist are convinced that the condition of the patient is stable. A sensible companion and instruction to the patient that he is not allowed to actively participate in road traffic are essential for discharge after surgery. The decision on outpatient or inpatient care must always be taken individually. It is not possible to make a general statement as to the manner in which an intervention should be carried.

[Ambulant Anesthesia: Organization in Medical Practices and Hospitals]. / Ambulante Anästhesie: Organisation in Praxis und Krankenhaus.

Legislation, regulations and rules must be complied with when conducting ambulant surgeries and administering ambulant anesthesia. Additionally, there are social welfare legislation and regulations, as well as technical guidelines and standards that must be complied with, for instance, regarding the management of medical products or the disposal of waste and sewage in medical practices. At a country level, many of these regulatory areas are managed differently by each German state, and in some instances management differs significantly from one state to another. Social and employment legislation, as well as regulations for ambulant operating physicians and business operators have to be observed. In order to prevent nosocomial infections, there is a focus on maintaining compliance with hygiene regulations and the Infection Protection Act. There are a variety of possible operational models and ways to organize ambulant operating rooms. The particular model that is best for a specific practice will depend on the local circumstances. That being said, particular attention should be given to patient-centered, stress free surgical patient care, which should be prioritized over the business. Ambulant surgery can be performed in private practices, as well as hospitals, and the two usually differ significantly from one another. On the one hand there are the well-organized, high performing, private practices, which have a focus on ambulant surgeries, where the participating physicians contribute to the success of the practice. On the other hand, there are the often large and cumbersomely organized hospitals, where ambulant surgeries are viewed as more of a burden than as an additional source of income.

[Risk management for ambulatory anaesthesia]. / Ambulante Anästhesie--Risikomanagement in der ambulanten Anästhesie.

Outpatient anaesthesia has increased considerably in recent years. More complex procedures are performed on an outpatient basis and patients suffer from more co-morbidities. A patient- and procedure-centred risk management system includes guidelines for patient-selection and -evaluation, selection of adequate anaesthetic drugs, structured post-anaesthesia care and discharge-procedures, and a critical incident management plan. Risk management for ambulatory anaesthesia is supposed to reduce malpractice and prevent complications. Ultimately, procedure related cost will decrease and confidence as well as satisfaction of patients, surgeons and anaesthesia team members will increase.