Do patients require "escorts" or "carers" for discharge following day surgery and office-based anesthesia? Both sides of the debate explored.

Over the past few years, there has been a rapid rise in office-based procedures, out of hospital and day surgery procedures, particularly as an effort to combat the escalating costs of hospital-based services. Coincident with this burgeoning demand for office-based anesthesia, is the accompanying increased risk of anesthesia and sedation-related complications. In the 1990's and 2000's, the risk of mortality was higher for anesthetics and sedations performed outside of the operating theater setting. Although guidelines exist for ambulatory and office-based anesthesia, they are being continuously reviewed and reconsidered. A challenge for office-based settings, is the expectation of having an "escort" available to assume responsibility for the patient at time of discharge from the post anesthesia care setting. Challenges in securing an escort can lead to delays, cancellations and same day patient "no shows." This expert review, the first one to ever be published on this topic, will explore the medicolegal, regulatory, pharmacologic and pharmacokinetic issues involved on both sides of this debate need to be carefully considered and understood, considering the pros and cons of requiring an escort for same day post anesthesia discharge.