SAMBA/IACTA PANEL At The IACTA 2017 PUNE Conference
The IACTA (Indian Association of Cardiovascular Thoracic Anaesthesiologists) 2017 Pune, India Scientific Committee had graciously agreed to host an IACTA/SAMBA (Society for Ambulatory Anesthesia) Panel on the 18th of February at their 2017 annual meeting held at the JW Marriott in Pune, India. The panel had 2 speakers from the U.S.A. and 3 from India (see Table 1 for the other panel speakers and topics and photo). The topic of the panel was “Ambulatory Cardio-Thoracic Procedures in Adults and Children”.
Table 1. Speakers at the SAMBA/IACTA Panel
Dr. Kumar Belani - Introduction to SAMBA and current status of ambulatory surgery with particular reference to same day cardiothoracic procedures (diagnostic and therapeutic) in adults and children
*Dr. Sambhunath Das - Report of ambulatory cardiothoracic procedures in India (diagnostic and therapeutic)
†Dr. Sheela Pai Cole - Report of ambulatory cardiothoracic procedures in USA (diagnostic and therapeutic)
¶Dr. Amish Jasapara - Time to establish an ambulatory section of IACTA (key issues to properly prepare and efficiently take care of these patients using appropriate perioperative techniques similar to a Surgical Home - with reference to India)
*Professor of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India. †Associate Professor of Anesthesiology, Stanford University, Palo Alto, U.S.A. §Associate Professor of Anesthesiology, U.N. Mehta Institute of Cardiology & Research CenterAhmedabad, India ¶Senior Consultant, Fortis Hospital, Mulund, Mumbai, India.
Dr. Kumar Belani, Professor and Division Chief of Pediatric Anesthesiology at the University of Minnesota and Vice President, SAMBA, led the panel and introduced the Society For Ambulatory Anesthesia (SAMBA) and provided information about its mission including recent interest and encouragement to enroll members from abroad. There are approximately 400 international members and it would academically advance both societies (SAMBA and IACTA) if members of IACTA joined SAMBA. Dr. Belani enumerated the goals and mission of SAMBA indicating its role in promoting education, encouraging research and offering professional guidance to the membership for advancing the practice of ambulatory anesthesia. Dr. Belani provided data demonstrating the growth in ambulatory diagnostic and therapeutic procedures in the USA to meet the changing health care delivery models. The current goal is to provide high-quality superior outcomes for patients in same-day surgery and diagnostic centers including doctors’ offices for appropriate procedures. Dr. Belani provided information on some of the same day pediatric cardiothoracic procedures done at the University of Minnesota Masonic Children’s Hospital in Minneapolis.
The SAMBA/IACTA panel members: Drs. Amish Jasapara, Sheela Pai Cole, Rajesh Thosani, Kumar Belani and Sambhunath Das.
Dr. Das from the All India Institute of Medical Sciences in New Delhi, India indicated that there were several cardiothoracic procedures that qualify for same day surgery. He reviewed publications in India that provided details on fast tracking and indicated that pre-anesthesia assessment is an important element as are short and rapid acting anesthetics during ambulatory care. The high population growth and disease burden dictate the need to provide safe and efficient ambulatory care in India.
Dr. Cole from Stanford University in Palo Alto, U.S.A. discussed diagnostic and therapeutic ambulatory cardiothoracic procedures done in the U.S.A. Again, she emphasized the need for proper patient selection including their optimization to avoid surgical surprises and plan anesthesia to avoid complications particularly PONV, emergence delirium and stroke. Strategies to facilitate early discharge include the use of the transfemoral approach for invasive procedures. Minimizing fluids is important for fast recovery and discharge.
Dr. Thosani from the U.N. Mehta Institute of Cardiology and Research reviewed the contraindications for ambulatory care for cardio-thoracic procedures. This includes patients with potentially life-threatening chronic illness (unstable angina, brittle diabetes, symptomatic asthma, symptomatic morbid obesity) and just like in the U.S.A. when there is no responsible adult caretaker at home. Health insurance policies in India may not include coverage for ambulatory care and could be a rate limiting step for expansion of this modality of care for the sub-continent.
Dr. Jasapara reviewed the readiness for India to grow the ambulatory surgery market. He indicated that the escalating cost of health care with decreasing reimbursements to providers and facilities posed significant challenges. Ambulatory care would provide significant advantage and decrease cost significantly (see Table 2). Using proper ambulatory anesthesia
Table 2. Ambulatory Perioperative Care - Advantages
Lack of dependence on the availability of hospital beds
Greater flexibility in scheduling operations
Low morbidity and mortality
Lower incidence of infection
Lower incidence of respiratory complications
Higher volume of patients (greater efficiency)
Shorter surgical waiting lists
Lower overall procedural costs
Lower incidence of VTE
Less preoperative testing and postoperative medication
approaches namely, temperature control, optimizing anesthesia dose, modification of surgical stress response with regional approaches, PONV prophylaxis and using minimally invasive surgical approaches will allow patients to recover rapidly and choose ambulatory facilities instead of hospitalization. Patient and family motivation will play an important role to expand ambulatory procedures in India, as will changes in government policies and insurance coverage.
Following the panel presentations, there was a brief discussion and several expressed an interest in becoming international members of SAMBA.