A case study: identification and treatment of narcotic depression in the ambulatory surgical patient.

The staff in a freestanding ambulatory surgical center (ASC) must be prepared to identify and treat all emergencies and untoward patient responses. This case study exemplifies some of the problems encountered with a patient who had surgery late in the day and who did not have local anesthetic infiltrated for pain control after inguinal herniorrhaphy. In a retrospective analysis and discussion of the case, the caregivers identified that, in addition to the narcotics given, this patient's lengthy postoperative course was further complicated by inadequate intravenous fluid replacement and ambulation too soon after narcotic administration. From this case study a number of lessons were identified, particularly for the freestanding ASC. These lessons relate to adequate staffing (two nurses) for late cases, the importance of the presence of the anesthesiologist at the center until all patients have been discharged, the need to assure that home conditions are adequate for patients discharged late in the day, and the staff's ability to quickly and accurately identify and treat untoward patient responses.