Discharging select patients without an escort after ambulatory anesthesia: identifying return to baseline function

Abstract

Purpose of reviewThe current standard of care requires ambulatory surgical patients to have an escort for discharge. Recent studies have started to challenge this dogma. Modern ultrashort acting anesthetics have minimal psychomotor effects after a couple of hours. Driving simulator performance and psychomotor testing return to baseline as soon as 1 h following propofol sedation. Recent findingsTwo recent reports of actual experience with thousands of patients found no increase in complications in patients who were discharged without escort or drove themselves from a sedation center. These studies suggest discharge without escort may be safe in select patients but a method to identify appropriate patients remains undefined. SummaryA reliable test to document return of function might allow safe discharge without an escort. Currently, there is intense interest in developing reliable, inexpensive, easy to administer psychomotor function testing to improve workplace safety and legally define the effects of drugs on driving impairment. Future studies may be able to adapt this technology and develop a validated test for residual anesthetic impairment.

Ambulatory anesthesia and discharge: an update around guidelines and trends

“…Escort and availability of subject to have support at home are without doubt of importance for safety. A recent review addressed the importance to consider impaired both motor and cognitive capacity, thus supporting escort [4 ▪▪ ]. An accelerometer was used in a study for assessing motor function recovery, it showed that full motor functionality returns slowly and not complete during 1 week after surgery [5 ▪ ].…”