Office-Based Anesthesiology: Does the Duration of Anesthesia Play A Role in
Patient Morbidity?
Marc E. Koch, MD MBA3, Robert C. Goldstein1, MD and Neil A. Gordon4 MD

Introduction - Attempts to limit the duration of surgery and anesthesia in office-based facilities, sometimes through legislative act, is not uncommon. The scientific underpinnings and outcome data do not conclusively support these initiatives. It may be that the type of surgery, fluid shifts, anesthesia provider type and technique are more important variables than case length. This retrospective study controls for all of the aforementioned variables and compares anesthetics less than four hours to those four hours or more, in terms of morbid events and amounts of anesthesia received.
Methods - This is a retrospective survey of 139 consecutive patients who underwent elective cosmetic facial plastic surgery [FPS] under GA from January 1 of 2001 through June 30 of 2001. All patients were intubated and received nitrous oxide, midazolam, fentanyl, propofol and non-depolarizing muscle relaxants as well as injections of local anesthesia with epinephrine into the operative site, if indicated by the surgical procedure.
Furthermore, they were all cared for by a BC Anesthesiologist and the same BC Otolaryngologist/FPS in an AAAASF Accredited office-based surgical facility [OBSF]. Surgical charts and anesthesia records were reviewed and data critiqued. Patients who were under anesthesia for < 240 minutes (Group I) were compared to patients who were under anesthesia for > 240 minutes (Group II). Morbidity indicators included hospital
admission, MI, CHF, respiratory arrest, neurological injury and delayed discharge (on account of intervening medical problems). Events occurring anytime during the immediate preoperative period through discharge from recovery were captured, as were those occurring within 7 days of discharge.
Results - A total of 125 patients, aged 10 to 78 had sufficient data for inclusion. A total of 26 (21%) and 99 (89%) patients were placed in Group I and II respectively. There was no statistically significant difference in the incidence of major morbidity and mortality between Group I and Group II. One patient in Group II had a prolonged recovery due to an anaphylactic drug reaction after induction. Their surgery was aborted and they were treated and discharged with subsequent evaluation by their personal physician; there was no further sequela. Another patient in Group II had a temporary peripheral nerve injury due to a sequential compression boot. This resolved without any intervention. None of the patients in either group suffered myocardial infarction, congestive heart failure or respiratory arrest. Group I patients received more than four times as much fentanyl (0.0255 vs. 0.0063 mcg/kg/min), nearly twice as much versed (0.6351 vs. 0.3107 mcg/kg/min), and approximately sixty percent as much propofol (69.48 vs. 113.66 mcg/kg/min) compared to patients in Group II.
Conclusion - Our data suggests that when anesthesia is provided by a BC Anesthesiologist, in an accredited OBSF, during the course of FPS performed by a BC Otolaryngologist/FPS, that prolonged anesthesia duration, in of itself, may not cause an increase in morbidity or mortality. Procedures expected to last > 240 minutes may be safely performed in the office-based environment and case duration may not be the best
predictor of where surgery or anesthesia should be provided. The fact that FPS does not involve substantial blood loss, fluid shifts, or stimulating operative maneuvers may partly explain our findings. More expansive studies must be performed to derive statistically significant data.

3 Clinical Assistant Professor of Anesthesiology, Dept of Anesthesiology SUNY at Stony Brook School of
Medicine
4 Clinical Instructor of Surgery, Dept of Surgery Section of Otolaryngology Yale University School of
Medicine

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