there any limitations set for types of patients/ procedures for office-based
According to the ASA “Guidelines for Ambulatory
Surgery and Anesthesia,” “patients who by reason of pre-existing medical or
other conditions may be at undue risk for complications should be referred to
an appropriate facility for performance of the procedure and administration of
anesthesia.” This leaves a very wide margin for interpretation. The
anesthesiologist must determine on an individual basis the risk/benefit for
each patient. Patients with a history of sleep apnea or obesity/morbid obesity
present unique challenges in the office setting. Other con-ditions that may preclude
an office-based anesthetic would include brittle diabetes, a history of
substance abuse, moderate to severe chronic obstructive pulmonary disease, or
risk of aspiration. Each case must be considered on its individual merits.
Over the past several years the procedures
performed in offices have increased in complexity and become more invasive in
nature. Some surgical procedures that may have required inpatient
hospitalization 10 years ago can now safely be performed in an office. However,
some proce-dures should still be avoided. These procedures would include those
that are associated with significant blood loss, fluid shifts, or hypothermia.
Procedures should not exceed 6 hours in duration and should be completed by
3:00 pm to insure adequate postoperative monitoring.