Many surgical procedures are done in outpatient settings. Patients are evaluated (eg, with laboratory tests—see Preoperative Evaluation) one to several days before the procedure.
The general rule is for patients to have no oral intake after midnight the night before surgery. For certain GI procedures, cleansing enemas or oral solutions must be started 1 to 2 days before surgery. When prophylactic antibiotics are needed before a procedure, the initial dose must be given within 1 h before the surgical incision.
Before discharge, patients should be free of severe pain and should be able to think clearly, breathe normally, drink, walk, and urinate.
If sedatives (eg, opioids, benzodiazepines) were used during an outpatient procedure, patients should not leave the hospital unaccompanied. Even after anesthetic effects have apparently worn off and patients feel fine, they are likely to be weak and have subtle residual effects that make driving inadvisable; many patients require opioids for pain. Elderly patients may be temporarily disoriented because of the combined effects of anesthesia and surgical stress and may develop urinary retention caused by immobility and anticholinergic drug effects.