Special Considerations for Office-Based Anesthesia

By February 1, 2016Health

Anesthesia can be administered in a variety of settings. Office-based anesthesia has become increasingly more common (1). Between 1995 and 2005, the number of elective procedures performed in offices doubled to approximately 10 million procedures per year. This increase in office-based anesthesia is due largely to newer surgical and anesthetic techniques and perceived economic advantage for office-based procedures. For some patients, office-based procedures may require less paperwork, provide greater privacy, and feel less imposing than hospital procedures (5). While there are advantages to office-based anesthesia, special considerations are needed to provide safe and effective care.

Compared to a hospital setting, an office-based setting would not be able to provide as much backup resources and support. Therefore, specific regulations must be taken into account to ensure patient safety (1). The American Society of Anesthesiologists (ASA) has a set of guidelines concerning the implementation of office-based anesthesia and the special considerations it requires (2). The American Association of Nurse Anesthetists (AANA) also has set standards for office-based anesthesia practice (3). These guidelines parallel many of the same fundamental standards for the ASA and AANA. Based on these guidelines, some special considerations include determining whether an office-based procedure is best for the patient, facility accreditation, and building and equipment safety.

Depending on the health of the patient and the type of procedure planned, office-based anesthesia may or may not be the best option. Reliable statistics on the morbidity and mortality of office-based anesthesia still remains difficult to analyze because of limited sample size and lack of uniform criteria for morbidity and mortality (1). However, there are some studies that find that office-based anesthesia is less safe than ambulatory surgical centers, with higher rates of adverse events and death associated with office-based anesthesia procedures (1). There is still some consideration as to whether these findings are valid. Nonetheless, patient safety remains to be a top concern for those advising patients considering procedures in an office setting versus a surgical center. Appropriate preoperative testing must be considered, and those with specific conditions, such as morbidly obese patients or those with sleep apnea, will likely be counseled to consider procedures in a hospital setting (5).

Another special consideration is that anesthesiologists and nurse anesthetists are responsible for ensuring that the facility and equipment are routinely inspected (1). This is especially important in office-based settings where a problem during a procedure may be more dangerous for patients. The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) and other accrediting institutions offers certification and accreditation to facilities that meet their standards (5). According to ASA’s guidelines, at a minimum, facilities “should have a reliable source of oxygen, suction, resuscitation equipment and emergency drugs” (6). Routine inspection is expected, and a back-up power supply should be available in case of emergency. Additionally, all personnel should be comfortable working in an office setting and regularly trained in the facility’s emergency protocols.

As office-based anesthesia has become more common, considerations for maintaining a safe office anesthesia environment has become a priority for many researchers and organizations. The ASA has even compiled an informal manual to supplement their formal guidelines (4). Interested readers can also find several textbook references regarding office-based anesthesia (1). Office-based anesthesia and surgery can provide proper conditions for procedures, and is seen by many to be a better option for some patients.

Sources:

  1. http://www.sciencedirect.com/science/article/pii/S1932227510000194
  2. https://www.openanesthesia.org/office-based-anesthesia-guidelines/
  3. http://www.aana.com/resources2/professionalpractice/Pages/Standards-for-Office-Based-Anesthesia-Practice.aspx
  4. https://www.asahq.org/shop-asa/detail?productId=133693
  5. https://www.thieme-connect.com/products/ejournals/html/10.1055/s-2007-979210
  6. http://www.asahq.org/~/media/Sites/ASAHQ/Files/Public/Resources/standards-guidelines/guidelines-for-office-based-anesthesia.pdf

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