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.
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