Succinylcholine for Emergency Airway Rescue in Class B Ambulatory Facilities: The Society for Ambulatory Anesthesia Position Statement.

Procedures in class B ambulatory facilities are performed exclusively with oral or IV sedative-hypnotics and/or analgesics. These facilities typically do not stock dantrolene because no known triggers of malignant hyperthermia (ie, inhaled anesthetics and succinylcholine) are available. This article argues that, in the absence of succinylcholine, the morbidity and mortality from laryngospasm can be significant, indeed, higher than the unlikely scenario of succinylcholine-triggered malignant hyperthermia. The Society for Ambulatory Anesthesia (SAMBA) position statement for the use of succinylcholine for emergency airway management is presented.

Paravertebral block: new benefits from an old procedure.

PURPOSE OF REVIEW: Paravertebral blocks are becoming increasingly popular, especially as an anesthetic adjunct for breast procedures. New reports suggest additional reasons for adding this block to the anesthetic armamentarium. RECENT FINDINGS: Recent studies demonstrate a benefit from preoperative placement of a paravertebral block, not only in reducing acute postoperative pain, but also statistically significant reductions in the percentage of patients that develop chronic postsurgical pain 1 year after surgery. Another study found that the breast-cancer recurrence rate at 36 months after surgery was lower in the paravertebral group compared with the general anesthesia-only group of patients. SUMMARY: Paravertebral blocks are a well established option to provide anesthesia and postoperative analgesia during breast surgery. Recent studies suggest additional benefits to this procedure. Not only is acute pain better controlled, but the development of chronic mastectomy pain syndrome and recurrence of cancer may be reduced by preoperative placement of paravertebral block. These studies provide additional reasons why this block should be considered as part of the anesthetic for breast surgery.

Comparative outcomes analysis of procedures performed in physician offices and ambulatory surgery centers.

HYPOTHESIS: This study compared outcomes to determine whether patient safety is similar in Florida ambulatory surgery centers and offices. DATA SOURCES: All adverse incident reports to the Florida Board of Medicine for procedure dates April 1, 2000, to April 1, 2002 were reviewed. The numbers of office procedures performed during a 4-month period were used to estimate the total number of procedures. Ambulatory surgery death summaries, adverse incident data, and volumes of procedures for 2000 were procured from the Florida Agency for Health Care Administration. STUDY SELECTION/DATA EXTRACTION: Adverse incident reports were reviewed by multiple parties; only reports that involved an office surgical procedure and resulted in injury or death were included in the outcomes calculation. Reports were extracted independently by multiple reviewers. DATA SYNTHESIS: Adverse incidents occurred at a rate of 66 and 5.3 per 100,00 procedures in offices and ambulatory surgery centers, respectively. The death rate per 100,000 procedures performed was 9.2 in offices and 0.78 in ambulatory surgery centers. The relative risks for injuries and deaths for office procedures vs ambulatory surgery centers were 12.4 (95% confidence interval, 9.5-16.2) and 11.8 (95% confidence interval, 5.8-24.1), respectively. CONCLUSIONS: In this review of surgical procedures performed in offices and ambulatory surgery centers in Florida during a recent 2-year period, there was an approximately 10-fold increased risk of adverse incidents and death in the office setting. If all office procedures had been performed in ambulatory surgery centers, approximately 43 injuries and 6 deaths per year could have been prevented.