{"title":"Practice management issues in office-based anesthesiology","authors":"Maria Galati MBA","doi":"10.1053/j.sane.2005.11.008","DOIUrl":"https://doi.org/10.1053/j.sane.2005.11.008","url":null,"abstract":"<div><p>Office-based anesthesiology (OBA) presents an opportunity for some anesthesiology practices to expand their scope and garner professional and financial growth opportunities. Practices that center their OBA feasibility analysis on their mission and objectives stand to be the most successful whether or not they decide to pursue an OBA venture. The steps in evaluating the risk/benefit of entry into OBA include a complete analysis of the anesthesiology practice’s mission and resources, and an evaluation of the prospective office site to assure it offers a safe and financially viable practice venue. An effective OBA implementation plan deals with the attendant legal and regulatory requirements, a client satisfaction program, and development of an administrative infrastructure to support and monitor the success of the venture as defined by the practice’s mission-based objectives.</p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"25 1","pages":"Pages 32-39"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2005.11.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91764365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Office-based anesthesia for the pediatric patient","authors":"Cheryl K. Gooden MD (FAAP)","doi":"10.1053/j.sane.2005.11.007","DOIUrl":"https://doi.org/10.1053/j.sane.2005.11.007","url":null,"abstract":"<div><p>There continues to be a growing trend in the number of office-based procedures. As a result, there is an increased demand for office-based anesthesia. The need for anesthetic services in the office is still greatest in the adult patient population. However, we are observing an increase in the need for anesthesia in the office environment for children. This review focuses on the issues that are pertinent to the clinician involved with pediatric office-based anesthesia.</p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"25 1","pages":"Pages 19-24"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2005.11.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91764368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Patient and procedure selection for an office-based anesthetic","authors":"Laurence M. Hausman MD, Isabelle deLeon MD","doi":"10.1053/j.sane.2005.11.006","DOIUrl":"https://doi.org/10.1053/j.sane.2005.11.006","url":null,"abstract":"<div><p>A key element in the delivery of a safe office-based anesthetic is the proper selection of suitable patients and procedures. Currently, there is a paucity of state or local regulations regarding this issue. However, a few medical societies have been active in developing recommendations and practice advisories. Additionally, our experience with free-standing ambulatory surgery centers should help guide in formulating policies that will insure that patient safety is not sacrificed in this exciting new healthcare venue.</p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"25 1","pages":"Pages 7-12"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2005.11.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91764367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Office-based anesthesia: Anesthetic techniques, drug selection, and discharge criteria","authors":"Michael Chietero MD, Ram Roth MD","doi":"10.1053/j.sane.2005.11.003","DOIUrl":"https://doi.org/10.1053/j.sane.2005.11.003","url":null,"abstract":"<div><p>Office-based anesthesia inherently possesses a number of unique challenges. Providing an effective anesthetic in this venue requires the use of fast-acting anesthetic agents with a high safety profile and minimal recovery time. Regardless of the anesthetic technique or specific agents selected, considerations for patient safety, rapid emergence, and prompt discharge are always of paramount importance. Additionally the anesthesiologist must consider issues such as postoperative pain and nausea and vomiting. In this article, anesthetic considerations and technical requirements to accomplish these objectives are discussed.</p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"25 1","pages":"Pages 13-18"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2005.11.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91680302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Regulatory issues in office-based surgery and anesthesia","authors":"David Wax MD","doi":"10.1053/j.sane.2005.11.005","DOIUrl":"https://doi.org/10.1053/j.sane.2005.11.005","url":null,"abstract":"<div><p>The continued rapid expansion of office-based surgery and anesthesia (OBS/OBA) makes it a new frontier of healthcare. Though its early years were somewhat marred by some negative publicity and bad outcomes, oversight and regulation by professional societies, governments, and private industry has now begun to catch up with OBS/OBA practice. Clinicians and administrators must stay abreast of these ever-changing/evolving regulations and guidelines in order to remain in compliance with them as well as to provide safe and satisfying patient care. This article summarizes the current regulatory environment in which OBS/OBA practices and practitioners must operate.</p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"25 1","pages":"Pages 25-31"},"PeriodicalIF":0.0,"publicationDate":"2006-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2005.11.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91764366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Positioning for central venous access","authors":"S. Sujanthy Rajaram MD, R. Phillip Dellinger MD","doi":"10.1053/j.sane.2005.10.006","DOIUrl":"10.1053/j.sane.2005.10.006","url":null,"abstract":"<div><p><span><span>Central venous access catheterization is one of the most common procedures performed by physicians. Site selection for access includes the </span>internal jugular vein and </span>subclavian vein<span><span><span>. Trendelenburg position likely decreases the incidence of venous </span>air embolism during these procedures. At least 25° of Trendelenburg position using the lateral approach and more than 20° of head rotation (maximum) results in the largest cross-sectional area of the internal jugular vein. The largest subclavian vein size is obtained when the patient is in moderate Trendelenburg position (15° head down) with the head straight up and the shoulders lying flat on the bed. The distance between the </span>sternoclavicular joint<span> and the point on the lower border of the clavicle at which the subclavian vein crosses, measured as overlap length (OL), increases with lower shoulder position. Lowering the shoulders facilitates needle entry into the subclavian vein, decreases the likelihood of an arterial puncture<span>, and reduces the risk of excessive needle advancement. Shoulder neutral position produces maximal overlap of the medial third or more of the clavicle. The “bump” position (shoulder forward with head turned) increases the likelihood of successful central venous catheter placement.</span></span></span></p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"24 4","pages":"Pages 211-213"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2005.10.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133539037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeffrey I. Gold PhD , Alexis J. Kant BA , Seok Hyeon Kim MD, PhD , Albert “Skip” Rizzo PhD
{"title":"Virtual anesthesia: The use of virtual reality for pain distraction during acute medical interventions","authors":"Jeffrey I. Gold PhD , Alexis J. Kant BA , Seok Hyeon Kim MD, PhD , Albert “Skip” Rizzo PhD","doi":"10.1053/j.sane.2005.10.005","DOIUrl":"10.1053/j.sane.2005.10.005","url":null,"abstract":"<div><p><span>Pediatric pain management for routine medical interventions continues to receive considerable attention. To date, investigators have demonstrated the efficacy of simple pain distraction strategies for acute procedures (ie, venipuncture) as well as more invasive interventions (ie, wound care, chemotherapy). Recent technological advances in the field of virtual reality (VR) have produced more engaging forms of pain distraction. Although </span>clinical case studies and randomized control trials have begun to explore the utilization of VR anesthesia, this research is still in its infancy. In spite of some limitations, VR researchers have successfully demonstrated its feasibility, satisfaction, and innovation for decreasing pain associated with medical interventions. VR anesthesia also has the potential to minimize pharmacological therapy, thereby reducing risks associated with sedation. Future directions in VR anesthesia are contingent on further technological advances, sound methodology, and appropriate participant-to-intervention match. This manuscript reviews current literature on state-of-the-art pain distraction and future directions in VR.</p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"24 4","pages":"Pages 203-210"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2005.10.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121887771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intraoperative EEG monitoring","authors":"William J. Loskota PhD, MD","doi":"10.1053/j.sane.2005.10.007","DOIUrl":"10.1053/j.sane.2005.10.007","url":null,"abstract":"<div><p>Intraoperative electroencephalographic (EEG) monitoring has become technically feasible in everyday clinical practice. Anesthesiologists should become familiar with the utility and indications for intraoperative EEG monitoring. An understanding of the EEG and the various descriptors of the EEG, including spectral edge frequency, density spectral array, and other parameters, is readily obtained. Clinicians can adapt these EEG parameters to their decision making process to guide therapeutic interventions or follow the course of pharmacologic manipulations. This article presents a discussion of the clinical application of routine intraoperative EEG monitoring with clinical examples and comparison of two commercially available monitors.</p></div>","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"24 4","pages":"Pages 176-185"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2005.10.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126886922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"We do exactly what every other anesthesia group does, so why are we doing so poorly?","authors":"Mark F. Weiss JD","doi":"10.1053/j.sane.2005.10.003","DOIUrl":"10.1053/j.sane.2005.10.003","url":null,"abstract":"","PeriodicalId":82686,"journal":{"name":"Seminars in anesthesia","volume":"24 4","pages":"Pages 226-228"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1053/j.sane.2005.10.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"103593791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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