Types of office-based anesthetics.

Over the past several decades, there have been evolutionary changes in both surgery and anesthesia. Newer anesthetics have excellent safety profiles and are associated with fewer hemodynamic side effects and rapid elimination from the body. Innovative surgical techniques are less invasive and cause less perioperative patient pain. These developments have fueled the growth of office-based surgery and anesthesia. All types of anesthesia, including local, monitored anesthesia care, general, and regional anesthesia, have been used safely within the private practitioner's office. Because of the remote nature of the private surgeon's office, the proper selection of both patient and procedure to be performed is of utmost importance. It is likewise imperative that the practitioner assures that the patient does not experience excessive postoperative pain and/or nausea and vomiting. It is of the utmost importance that the practicing anesthesiologist assure that every location in which procedures and surgeries are performed is a safe anesthetizing location.

Anesthesia for cosmetic surgery.

Increasing numbers of plastic surgery procedures are performed in diverse environments, including traditional hospital operating rooms, outpatient surgery centers, and private offices. Just as plastic surgeons develop areas of specialization to better care for their patients, anesthesiologists have specialized in outpatient plastic surgery, both cosmetic and reconstructive. The methods they utilize are similar to those for other procedures but incorporate specific techniques that aim to better relieve preoperative anxiety, induce and awaken patients more smoothly, and minimize postoperative sequelae of anesthesia such as nausea and vomiting. It is important for plastic surgeons to understand these techniques since they are the ones who are ultimately responsible for their patients' care and are frequently called on to employ anesthesiologists for their practices, surgery centers, and hospitals. The following is a review of the specific considerations that should be given to ambulatory plastic surgery patients and the techniques used to safely administer agreeable and effective anesthesia.

Providing safe sedation/analgesia: an anesthesiologist's perspective.

Over the past several years office-based procedures with sedation have become increasingly more common. It must be appreciated that not all procedures are well suited for this type of environment. Unacceptable ones would include those associated with significant fluid shifts, post-operative pain, bleeding or procedures of long duration. Since esophagogastroduodenoscopy (EGD) and colonoscopy are relatively non-invasive, of short duration, and not associated with either fluid shifts or significant post-procedure discomfort. In appropriate patients, these procedures are well-suited to office-based practice.

The safety and efficacy of regional anesthesia in an office-based setting.

STUDY OBJECTIVE: To determine the safety and efficacy of regional anesthesia techniques when administered in the office-based setting. DESIGN: Retrospective chart review. SETTING: Free-standing orthopedic office with an operating room suite. MEASUREMENTS: A total of 238 patients underwent 242 anesthetics. Types of anesthetics delivered were quantified. Regional anesthetics were further divided into specific nerve blocks. Times from anesthetic start to surgical start and from surgical end to anesthetic end were calculated. Adverse outcomes were ascertained and followed. MAIN RESULTS: Of the 242 anesthetics administered, 123 were peripheral nerve blocks, two were neuraxial blocks, 140 were monitored anesthesia care cases, and 17 were general anesthetics (14 Laryngeal Mask Airway cases, two mask ventilation cases, and one endotracheal intubation). The average times from anesthesia start to surgery start were as follows: monitored anesthesia cases, 19+/-7 min (median, 20 min); regional anesthesia cases, 29+/-11 min (median, 30 min); and general anesthesia cases, 31+/-11 min (median, 30 min). The average time from surgery end to anesthesia end for monitored anesthesia cases was 9+/-3 min (median, 10 min); regional anesthesia, 9+/-3 min (median, 10 min); and general anesthesia, 12+/-4 min (median, 20 min). Two transient nerve injuries occurred, both of which resolved. CONCLUSIONS: On the basis of our experience, we believe that regional anesthesia can be delivered efficiently and safely for orthopedic procedures in the office-based environment, and we encourage its wider use.

Office-based surgery: expanding the role of the anesthesiologist.

Office-based anesthesia (OBA) has developed in the United States as an important field for the anesthesia provider. Both the numbers and types of procedures performed in offices around the country have steadily increased, as has the invasiveness of these procedures. New anesthetic considerations arise. For example, most training programs have not addressed this area of practice. Indeed many practitioners are unfamiliar with practice outside the hospital operating room setting. Information as to how to provide quality care in a location where one may be the sole anesthesiologist must be readily available. Many of the safety mechanisms we take for granted in a hospital setting are often not present in a surgical office, and it becomes the responsibility of training centers to help in establishing standards. As the 'safety' of many surgical offices where anesthesia care is provided has been challenged, medical societies have begun to issue recommendations as to the standards of care that should exist. Different anesthetic techniques are also emerging that are appropriate to the office setting. But as office-based anesthesia continues to mature as a specialty, we the anesthesia providers, must be proactive in establishing guidelines and recommendations to ensure safe practice.

A survey evaluating the training of anesthesiology residents in office-based anesthesia.

STUDY OBJECTIVE: To determine the current status and future plans of residency programs to train residents in office-based anesthesiology (OBA), which is rapidly emerging as an important specialty within the field of anesthesiology. DESIGN: Survey questionnaire. SETTING: University hospital. MEASUREMENTS: A 14-question survey was sent to the 134 listed members of the Society of Academic Anesthesia Chairs/Association of Anesthesiology Program Directors to elicit the current status of educational endeavors and clinical exposure of anesthesiology residents to this type of practice. MAIN RESULTS: There were 95 respondents (72%). Fifteen (15.8%) academic anesthesiology programs provide OBA services in the community and two (2.1%) of the academic programs provide clinical exposure to their residents. CONCLUSIONS: Residents are receiving minimal, if any, exposure to OBA during their training.

Advances in office-based anesthesia.

PURPOSE OF REVIEW: The practice of office-based anesthesia is quickly emerging as an important field for the anesthesia provider. The number of procedures being done in offices around the country has steadily increased, as has the invasiveness of these procedures. This creates new anesthetic considerations. To date most training programs have not addressed this area of practice. As practitioners enter the field, however, they should have information as to how to provide quality care in a location where very often they are completely alone. Many of the safety mechanisms we as anesthesia providers take for granted in a hospital setting are often not present in a surgical office, and it becomes our responsibility to help in establishing standards. RECENT FINDINGS: Some questions exist as to the 'safety' of many surgical offices in which anesthesia care is provided. Many medical professional societies have begun issuing recommendations as to the standards of care that should exist. Different anesthetic techniques are also emerging that are appropriate to the office setting. SUMMARY: As office-based anesthesia continues to mature as a specialty, we the anesthesia providers must be proactive in establishing guidelines and recommendations to make the practice safe. We should be informed of the rules and regulations that exist in our states, and we should provide a voice for the patients who put their faith in us.