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Ambulatory surgery comprised up to 70% of scheduled surgery in the USA during the past decades. The main reason for the increase was economic. In Japan, day surgery has been performed in the pediatric field, such as for inguinal hernia. However, recently day surgery has been performed in adult patients, because of medical economics as well as to improve the quality of life of patients. Patient safety is the most important issue in the increasing number of day surgeries in Japan. Postoperative care occurs at home. To reduce postoperative complications, skilled surgery, prompt recovery from anesthesia, and postoperative care using sophisticated systems, manpower, and equipment are necessary. To ensure patient safety, the Japan Society for Ambulatory Anesthesia announced a set of "safety standards for ambulatory anesthesia" in 1999 and we continue to work to developing protocols that maximize the safety of and benefits to patients.

The preoperative visit by an anesthetist has been thought to be important for the assessment of patient and to communicate with them. However, there are few reports on the visit in Japan until now. The effect of preoperative anesthetic visit in our hospital was estimated by interviewing patients just before surgery who had received a visit by their anesthetist. The answers from sequential 346 scheduled surgical patients for 8 weeks were obtained. Only 72 patients were able to recall the name of their anesthetists. About half of patients believed that anesthetist just had put the patient to sleep and relieved them from pain. We measured the number of treatments each patient could remember that had been explained by the anesthetist on the visit, and found it was unexpectedly small at the interview. These data suggest that our preoperative visit may not be satisfying in view of making good relationship between patients and anesthetists, and educating patients for recent anesthesia. We should make an effort to educate the patients about up-to-date and reasonable anesthesia.

We analyzed anesthetic records to obtain formulae to evaluate circulatory stability during anesthesia. Eight anesthesiologists graded circulatory stability based on 67 consecutive anesthetic records. Median of the grade, on the maximum of 10 points, was determined as the criterion variables for multiple regression analysis. The explanatory variables were: age, weight, height, heart rate, anesthesia time and systolic as well as diastolic blood pressure. Interdependent parameters were not used for this analysis. Adequate numbers of the explanatory variables were determined when Akaike's information criterion (AIC) was minimal. Two different analytical methods were used. One of the most suitable formulae to express circulatory stability throughout anesthesia was: 9.28-0.012 x A-0.017 x SPmax + 0.013 x SPmin-0.009 x HRmax A: age (year) SPmax: maximal value in systolic blood pressure (mmHg) SPmin: minimal value in systolic blood pressure (mmHg) HRmax: maximal value in heart rate (bpm) We conclude that these formulae obtained are useful to evaluate circulatory stability during anesthesia.