Ambulatory anesthesia has continued to expand due to the growth of minimally invasive surgery and the desire to reduce the overall cost of care. It has a much wider scope with inclusion of ASA physical status III and IV patients whose systemic diseases have been medically stabilized. Efficient pre-operative screening in a clinic or by telephone, minimal laboratory testing and an anesthetic technique geared toward reducing side effects and an early discharge let the provider curtail cost and decrease inconvenience to the patient.