Are there relative or absolute contraindications to the administration of a general anesthetic in the ambulatory setting?
Sometimes the administration of a general anesthetic clearly should be avoided, if possible. Examples of such cases are a patient with severe, poorly controlled asthma or documented bullous emphysema. In these cases, lesser concern should be given to the possibility of a postdural puncture headache (PDPH) if more serious sequelae are likely to result during or after administration of a general anesthetic. This, however, is the exception rather than the rule, and in most instances the final choice of anesthesia should remain with the patient, guided, of course, by the anesthesiologist. Additionally, when a patient arrives for extremely minor surgery without an escort, a local anesthetic injection alone might suffice for anesthesia. This might allow the patient to return home unaccompanied. Unfortunately, it sometimes becomes necessary to supplement a local anesthetic with intravenous sedation, and under these circumstances an escort would then be mandatory.