PRESIDENT'S ADDRESS - Back to SAMBA Talks


It is a true honor and privilege to follow Dr. Kathryn McGoldrick and the others who have served as president of the Society for Ambulatory Anesthesia. These individuals have been friends and mentors to me, and true leaders in the profession of anesthesiology. I would particularly like to acknowledge Dr. Surinder Kallar, a founding member and early president of SAMBA, who was my teacher and mentor and is responsible for my involvement in this organization.

As we have accumulated experience with ambulatory anesthesia, it has evolved and become a large portion of many people’s practice. Advances in anesthetic agents and techniques, particularly newer more flexible drugs and the incorporation of regional anesthetic techniques, have allowed us to broaden the landscape of cases and patients acceptable in the ambulatory setting. Perhaps in light of this, it is no longer a subspecialty in the way that it was 20 years ago when ambulatory practice was a true niche. However, I would maintain that it is still a true specialty in requiring knowledge of what can safely be done in the ambulatory setting, ability to provide rapid emergence with a low side effect profile, and attention to efficiency and to positive interactions with patients during high volume work.

Although our meetings are probably SAMBA’s most visible endeavor, there are many other functions members should be aware of. During the 2004 annual meeting in Seattle, a strategic planning session confirmed SAMBA’s mission statement: “SAMBA is the professional society dedicated to advancing the highest quality of science, education and patient care in the specialty of ambulatory anesthesia,” and adopted the motto “Defining the Care of the Ambulatory Patient”.

SAMBA is well known for quality educational programs in the annual meeting, midyear meeting (one day prior to the ASA) and breakfast panel at the ASA. Over the last several years we have worked hard to provide quality programs at a reasonable cost to attendees and without financial liability to the organization. The last two annual meeting programs have been very well received and have had a small budget surplus for the organization. Similarly, our midyear meetings have been popular in the last several years. Look for outstanding MYM and breakfast panel programs in New Orleans in conjunction with the 2005 ASA. The SAMBA newsletter (Ambulatory Anesthesia) and e-Newsletter (SAMBA Talks) also provide educational information, keeping members abreast of new developments in ambulatory anesthesia presented at meetings and in the literature. The e-Newsletter has a monthly summary of literature articles relevant to ambulatory anesthesia.

SAMBA has always placed a high value on resident education with research and travel awards to the annual meeting. We are fortunate to have the Abbott Chief Resident Symposium presented in conjunction with the SAMBA meeting, and we welcome resident attendees to our programs and workshops. For the last several years SAMBA has provided a panel/discussion session geared for residents, and this year a Resident Section was formed to better meet the needs of our resident members and to offer them enhanced exposure to organized medicine and to leadership roles.

SAMBA’s annual meeting and midyear meeting chairs participate in the ASA Committee on Professional Education Oversight, which keeps us involved in the larger picture of anesthesiology continuing education. Other educational opportunities that SAMBA may consider are weekend workshops presented in regional venues; web-based CME, and monographs on topics relevant to ambulatory anesthesia. The Committee on Regional Anesthesia has just completed a monograph on regional anesthesia in ambulatory practice, which will be published this summer as an issue of the International Anesthesiology Clinics.

SAMBA’s support of research includes the SAMBA Outcomes Research Award grant, a two year grant awarded on a competitive basis. The first recipient in May 2000 was Dr. Lee Fleisher whose research was on the impact of location of care and patient factors on the rate of complications and readmission after outpatient surgery. Dr. Karen Nielsen received the second Outcomes Research Award in May 2004; her study is on the impact of depth of anesthesia and dexamethasone on postoperative cognitive dysfunction. SAMBA also supports research awards for abstracts submitted to our annual meeting. Areas of possible further research are being evaluated, including benchmarking data and/or an outcomes research database.

Although the clinical practice of ambulatory anesthesia is diverse, SAMBA has formed several clinical committees to offer focused attention on rapidly expanding areas, including office-based anesthesia and regional anesthesia. We are exploring other possibilities for SAMBA’s involvement in providing support in administrative areas, and have recently formed an Ad Hoc Committee for Medical Directors, which will serve as a resource to individuals in that role.

Members frequently ask whether SAMBA can provide consensus guidelines on various areas of concern. While we try to provide the most recent information to help members and meeting attendees make clinical judgments, developing practice guidelines frequently requires a significant infrastructure and expense. Evidence-based guideline development, as undertaken by the ASA on a number of issues, is beyond SAMBA’s scope (in cost and personnel requirements). Consensus guidelines, however, may be feasible on a limited number of topics. I will be appointing a task force to examine SAMBA’s approach to this issue. Meanwhile, the SAMBA board did endorse support for revision of the consensus guidelines on postoperative nausea and vomiting prepared several years ago by Dr. TJ Gan and colleagues.

Regarding political and regulatory issues in ambulatory anesthesia, it was envisioned in the early years of SAMBA that SAMBA and ASA would have somewhat complementary functions – SAMBA focusing more on education and research in ambulatory anesthesia, and ASA fulfilling the political and regulatory agendas through the Ambulatory Surgical Committee. There has been ongoing interaction between SAMBA and the ASA Ambulatory Surgical Committee such that we are confident that our agenda is being well represented. The SAMBA president and president-elect serve on the ASA Committee on Anesthesia Subspecialties. SAMBA also has representatives to the regulatory agencies JCAHO and AAAHC, and to the International Association of Ambulatory Surgery (IAAS). We have interfaced as needed with the FDA (through Dr. TJ Gan on the droperidol issue) and continue to watch the changing face of medicine and anesthesia practice.

SAMBA has included outreach efforts over the last several years, notably through the continuing efforts of the Committee on International Relations and the creation of the Committee on Latin American Relations. At the recent request of Italy’s ambulatory surgery committee, we will be exploring interaction with that group as well.

SAMBA’s membership committee continues to look at ways to support our members and broaden our membership. A new category of corporate membership was ratified in a bylaws change this year. We also encourage participation of our members in SAMBA committees and consider the committees a vital part of how we provide services. The Board of Directors met this May to review and revise the committee structure and provide any needed clarification of function, so that our committees are able to support our mission and keep the organizational agenda moving forward.

Finally, behind the scenes our efforts are focused on keeping SAMBA financially strong, in order to provide a good value to members and meeting attendees. We continue to attempt to define optimal ways to interact with our corporate sponsors and have seen a good resurgence of industry support over the last few years. In addition to financial strength, maintaining a vibrant organization requires input from our membership. We will be putting together a “SAMBA Survey” to better assess needs of the membership as well as to get some basic survey information on various practice issues. Keep an eye out for the announcement and please participate. In the meantime, feel free to send any comments you have to the SAMBA office at SAMBA@asahq.org. Thank you for the opportunity to serve as SAMBA’s president.

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