Ambulatory, Nonoperating Room, & Office-Based Anesthesia
Outpatient/ambulatory anesthesia is the subspecialty of anesthesiology that deals with the preoperative, intraoperative, and postoperative anesthetic care of patients undergoing elective, same-day surgical procedures. Patients undergoing ambulatory surgery rarely require admission to a hospital and are fi t enough to be discharged from the surgical facility aft er the procedure.
Nonoperating room anesthesia (or out of the operating room anesthesia) refers to both inpatients and ambulatory surgery patients who undergo anesthesia in settings outside of a traditional operating room. Th ese patients can vary greatly, ranging from claustrophobic individuals in need of anesthesia for magnetic resonance imaging (MRI) procedures to critically ill septic patients undergoing endoscopic retrograde cholangiopancreatography in the gastrointestinal suite. Out of the operating room anesthesia requires the anesthesia provider to work in remote locations in a hospital, where ease of access to the patient and anesthesia equipment is compromised; furthermore, the staff at these locations may be unfamiliar with the requirements for safe anesthetic delivery.
Office-based anesthesia refers to the delivery of anesthesia in a practitioner’s Office that has a procedural suite incorporated into its design. Office-based anesthesia is frequently administered to patients undergoing cosmetic surgery, and anesthesia for dental procedures is also routinely performed in an office-based setting.
Although treatment may be similar for inpa-tients, ambulatory surgery center patients, out of the operating room patients, and office-based anesthesia patients, there are nonetheless various guidelines and statements from the American Society of Anesthesiologists (ASA) that pertain to these differ-ent locations. All of these recommendations should be reviewed at the ASA website (www.asahq.org/For-Healthcare-Professionals/Standards-Guidelines-and-Statements.aspx), as they are subject to changeand modification. In their guidelines and state-ments, the ASA reminds anesthesia staff that itis important that both the physical and operational infrastructure is in place at any location to ensure the safe conduct of anesthesia. In addition to the ASA guidelines, state regulatory guidelines, which include specific requirements for safety, governance, and emergency protocols for both office-based and free-standing ambulatory surgery centers, have also been established. Accreditation agencies, such as the Joint Commission, Accreditation Association for Ambulatory Healthcare, and American Association for the Accreditation of Ambulatory Surgical Facilities, engage in various inspections and reviews to ensure that facilities meet acceptable standards for the procedural services provided. Anesthesia staff should confirm that both the infrastructure and operational policies are consistent with acceptable anesthesia practice standards before providing anes-thesia in such settings.