Office-based Anesthesia: Successes and Challenges

O ffice-based surgery (OBS) accounted for 10 million of all elective procedures performed in the United States in 2005 and has doubled since 1995. Although there are no good national registries to accurately determine the number of surgical procedures occurring in offices, the projections have ranged from 17 to 24% of all elective ambulatory surgery procedures. This phenomenon has paralleled, and was certainly driven by, the huge increase in demand for cosmetic surgery over the past 10 years. Newer surgical and anesthetic techniques have allowed more invasive procedures to be performed in nonhospital settings. Economic advantages and physician and patient convenience have fueled the rapid growth of OBS and office-based anesthesia (OBA). Other advantages of OBS include ease of scheduling, greater privacy, lower cost, no risk for nosocomial infection, increased efficiency, and consistency in nursing personnel (Supplemental Digital Content 1, http:// links.lww.com/ASA/A302). Despite these advantages, OBS is not embraced by all surgeons nor is it appropriate for every patient or surgical procedure. In addition, OBA requires a different approach than that used in hospitals and ambulatory surgery centers. The rapid growth of OBA has not been uniformly accompanied by adherence to safety standards followed in hospitals or ambulatory surgery centers. The current status of OBA and challenges faced by office-based anesthesiologists regarding patient safety, patient and procedure selection, and anesthesia management for adult patients are the subject of this chapter.