Office-based anesthesia: dispelling common myths.
BACKGROUND
Running parallel with-and perhaps driven by-the huge increase in demand for cosmetic surgery, office-based anesthesia (OBA) is the fastest growing segment of anesthesia practice. Despite this, only 2% of anesthesiology residencies provide exposure to OBA, and many practicing anesthesiologists are not convinced that OBA techniques provide safe, reliable, and effective anesthesia care.


OBJECTIVE
To examine OBA techniques and safety records while addressing some of the commonly held beliefs among anesthesiologists regarding OBA.


METHODS
A review of 4800 patients undergoing 5264 cosmetic surgical procedures performed between 1997 and 2007 at Dudley Street Operatory (licensed in Rhode Island as a Physician Office Setting Providing Surgical Treatment and certified by the American Association for Accreditation of Ambulatory Surgery Facilities) was conducted. The primary anesthetic technique was deep sedation with a propofol ketamine infusion, combined with local anesthetic injection. Intercostal nerve blocks were performed before surgery in patients who had breast surgery and/or abdominoplasty. Endotracheal or laryngeal mask airway techniques were not used, nor were paralyzing agents, anesthetic gases, or vapors.


RESULTS
There were 16 unanticipated postoperative admissions in 10 years, all but 3 from surgical complications (hematoma, infection, and pneumothorax during dissection for breast implants). One patient had an acute reaction to a small volume of local anesthetic injected into the nasal septum, one patient with a history of panic attacks had an acute anxiety attack manifested as chest pain, and one patient refused discharge from the operatory to home after a face lift, despite meeting postanesthesia care unit discharge criteria, and was admitted overnight to the hospital. There were no hospital admissions because of pain, nausea, or excessive sedation.


CONCLUSIONS
In experienced hands, OBA techniques deliver an anesthetic for office-based cosmetic surgery superior to the usual general anesthesia performed in hospitals and ambulatory surgical centers. These techniques are safe, do not require expensive equipment other than an infusion pump and vital signs monitor, avoid sore throats and nausea, provide postoperative analgesia, and are well received by patients and surgeons. OBA presents an opportunity for anesthesiologists and aesthetic surgeons to partner for greater patient satisfaction.
Blake
Douglas R
DR
Warren Alpert Medical School, Brown University, Providence, RI, USA. dblake139@cox.net
D000556:Ambulatory Surgical Procedures; D000758:Anesthesia / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007442:Intubation, Intratracheal; D007649:Ketamine / Q000494:pharmacology; D009407:Nerve Block / Q000379:methods; D019651:Plastic Surgery Procedures
D007649:Ketamine