Volume 4, Issue 11 S A M B A T A L K S - PAGE 1 April, 2005

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Do you have a problem case or situation in ambulatory anesthesia about which you would like some advice? Would you like to reply to questions others have raised about ambulatory anesthesia issues? Do you have any comments or opinions regarding any topic related to ambulatory anesthesia which you would like to share with other professionals? If you answered "yes" to any of the above, then "Join the Discussion" here.

To enter the Discussion with a question, reply, or other comment, please contact us. Your question/reply/comment will be published in this section of the next available issue of SAMBA TALKS. Include your name (or initials), city, and state, if you would like these published. Please note that because of the high volume of questions we receive, there is often a delay of 1 to 2 months before the questions can be published.

Questions and responses from previous months are now available at the eNewsletter Discussion Archive. If you have any comments regarding the previous questions, please submit them to SAMBA Discussion, and they will be published here next month.

Please note: The information presented in the below replies does not represent SAMBA policy. The replies are solely the opinions of the individuals who wrote them.

?? - PREVIOUS MONTH'S QUESTION WITH A NEW REPLY - ?? - TOP

QUESTION:

Should pregnant patients receive anesthesia (general, Bier blocks, axillary blocks) for surgery in free-standing ASC's? Would doing digital or wrist blocks place any risk on the ASC?

-- Anonymous

REPLY:

I feel compelled to add one caveat to the comments on operating on pregnant patients in an ASC or surgical hospital. When fetal monitoring is indicated, one needs to have the staff with the demonstrated and documented competency as well as the equipment. Most ASC's can have the monitors but probably would not have the lawyer-proof staff in the unlikely event that the pregnancy became a problem. For that reason we do not do any pregnant patients at our facility.

-- From Lou Freeman M.D., Fresno, CA

?? - LAST MONTH'S QUESTION WITH REPLY - ?? - TOP

QUESTION:  

I am a non-physician quality administrator working with a pediatric task force in a mid west hospital. Several questions have come up that I thought I would pose to your group: What does the SAMBA &/or ASA say about administration of chloral hydrate to pediatric patients for the purposes of sedation during or prior to OP procedures?  Are there guidelines which address specific agents like chloral hydrate for the purposes of sedation and what do their guidelines look like?    

-- From Steven C. Thayer, Grand Rapids, MI

REPLY:

The ASA and SAMBA have no policy statements or guidelines concerning the use of specific sedatives such as chloral hydrate. However, the ASA and the American Academy of Pediatrics both have guidelines that govern the administration of sedatives to children. These guidelines are based on the intended level of sedation, and focus on the types of personnel that must be present, and the types of safety monitoring. In general, there are 3 levels of altered consciousness: moderate sedation, deep sedation, and general anesthesia. If one chooses to sedate a child, then they have to be prepared to rescue that child from a level of consciousness beyond that intended. The most common scenario being the intention of moderate sedation, with the credentials for rescuing a child from deep sedation.

For further information please see the following:

1. Committee on Drugs, American Academy of Pediatrics: Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures. Pediatrics 1992; 89: 1110-1115
2. American Society of Anesthesiologists, Task Force on Sedation and Analgesia by Non-Anesthesiologists: Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 1996; 84: 459-471
3. http://www.jcaho.org/accredited+organizations/ambulatory+care/standards/

-- From Ron Litman, D.O., Merion Station, PA

?? -- THIS MONTH'S QUESTION -- ?? - TOP

QUESTION:

It is generally accepted that patients should be accompanied by an adult when they are discharged home from ambulatory surgery, but does anyone have any policies about requiring someone to actually stay with the patient overnight after their ambulatory surgery?

-- Anonymous

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