The unique characteristics of spinal anesthesia recommend it for outpatient surgical procedures. The technique is easily and safely performed on patients in the lateral, sitting, or jacknife position with a variety of agent preparations tailored to the surgical requirements. New needle technologies have made postdural puncture headache uncommon ( ̃1%). Sedation is often provided to minimize patient anxiety, both preoperatively and intraoperatively, usually to the satisfaction of patients who expected to “go to sleep” for their operation. The distribution of spinal anesthesia can be targeted to a specific patient population and procedure, although interindividual variability limits predictability. Vigilance is paramount to managing spinal anesthesia, because minor side effects as well as severe bradyarrythmias and cardiac arrest may occur. Lidocaine has the optimal onset and duration profile for most outpatient anesthesia. However, transient neurologic symptoms (TNS) occurring after lidocaine spinal anesthesia have recently been documented. TNS can be markedly uncomfortable and occur to some degree in approximately 20% of outpatients receiving lidocaine. Mepivacaine does not appear to offer any advantage over lidocaine, whereas procaine may cause a lower incidence of TNS. Bupivacaine has the lowest associated incidence of TNS, and has been adapted for ambulatory surgery by using small doses in the 5 to 10 mg range. Adjuncts such as fentanyl can improve the success rate of small-dose spinal anesthesia without prolonging discharge time. Overall, factors that encourage early voiding will minimize time to home readiness. Anticoagulated patients need special consideration in light of new therapies and indications. Copyright © 2000 by W.B. Saunders Company