SAMBA Talks eNewsletter - November, 2005

Volume 5, Issue 6

S A M B A T A L K S - PAGE 2

November, 2005

JOIN THE DISCUSSION - TOP

Need advice about a problem case in ambulatory anesthesia? Want suggestions about a difficult situation in your ambulatory surgery center? Have a reply to questions others have raised about ambulatory anesthesia issues?

If you answered "yes" to any of these questions, or would like to share with other professionals a comment or opinion on a topic related to ambulatory anesthesia then please "Join the Discussion" here.

To enter the Discussion with a question, reply, or other comment, please contact us. Your submission 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 replies below does not represent SAMBA policy. The replies are solely the opinions of the individuals who wrote them.

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

HOW DO YOU CONVINCE SURGEONS TO FOLLOW GUIDELINES?

"How do you convince surgeons to follow the ASA guidelines on NPO status? Some of our surgeons want ALL patients NPO after midnight, including infants and children, some of whom are not done until late morning or in the afternoon. Do most institutions follow the guidelines?"

-- From Linda Logan, CRNA

REPLY

"I believe that most institutions follow the ASA guidelines, or have minor modifications to suit individual situations. My guess is that your surgeon is not ignorant of the evidence behind the change in NPO times. Most likely he or she has suffered a few cancellations from some anesthesiologists for "NPO violations" and does not want to take a chance again.

What you may want to try is to promise that patients will not be canceled or delayed for NPO violations. To ensure safety, you'll need to make sure that the nurses who make preoperative phone calls give patients proper instructions. You may want the parents to know of the new guidelines and thank the surgeons for not starving their kids and stress the fact that the kids were happier coming in for surgery.

If all else fails, you may want to make this a QA initiative by looking at the fasting times for all surgeons, and make this one stand out as the odd one. Peer pressure often works."

-- From Raafat S. Hannallah, MD, Washington, DC

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

SHOULD OUTPATIENT SURGERY CENTERS DO ASA CLASS IV PATIENTS?

"We are a free standing outpatient surgery center. Currently, we do not do ASA Class IV patients. However, we are seeing more and more patients presenting as Class IV. It seems as if we are cancelling more and more patients due to ASA 4 classifications. We do a lot of cataracts and many of those pts. have a lot of health issues. Are there any other outpatient surgery centers that do ASA IV under general anesthesia?"

-- From Diana McDaniel, MSN, CASC

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