SAMBA Talks eNewsletter - October, 2005

Volume 5, Issue 5

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

October, 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 REPLIES - ?? - TOP

DO OFFICE-BASED PROCEDURES COMPROMISE CARE?

The following question was addressed to colleagues in surgical and other procedural specialties:

"Do you believe that you are compromising patient care and/or safety by doing procedures in your office vs. a hospital setting?"

-- From Anonymous

REPLY:

"The short answer is NO.

and the long answer is NO..........if I felt otherwise, or in a particular patient's case, I would either not do the surgery at all (that is the most likely scenario)......or make whatever arrangements I felt I needed.

I think office based surgery (OBS) is safer, cleaner, more efficient (ie. less anesthesia time) and on and on. I have had 3 plastic surgeon's wives as patients and they were all done here.

It is not very pleasant to be in a hospital holding area with little privacy and waiting for your facelift while the patient in the next bed may be HIV positive and may be having an enema for a GI procedure.

-- From a Plastic Surgeon

REPLY:

"I do not believe there is compromise. I am selective with surgery. I avoid higher risk patients ie. (obese, pulmonary, CAD, Bad airway). The staff here is expert in the type of procedures I do which means they can be performed in a shorter time with increased safety."

-- From a Gastroenterologist/Colorectal Surgeon

REPLY:

"I disagree that patient care is compromised in an office based setting. I feel that any physician that follows unsafe practices either in the hospital or in his office compromises patient safety. I generally use more expensive, shorter acting anesthetics in my office with only the most competent anesthesiologists present (Anesthesiologists that I have worked with before and approved of their techniques). In the hospital bases setting, you have little control over the anesthesiologist, type of anesthetics or the technique that they use. It is rare that I see Sevoflourane as the primary gas and Propofol as the primary IV agent in the hospital setting. Finally, you must consider that continuity of care in an office is far superior to that of a hospital. This is in part due to the same nursing staff treating and recovering the same type of surgical patients. They know what to look for and better comprehend potential complications in this smaller cross section of surgical patients."

-- From a Plastic Surgeon

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

"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

TOP

PAGE 1 PAGE 3