++
KEY CONCEPTS
Non–operating room anesthesia requires the anesthesia provider to work in remote locations in a hospital, where ease of access to the patient and anesthesia equipment may both be limited; furthermore, the support staff at these locations may be unfamiliar with the requirements for safe anesthetic delivery.
Anesthesia providers should confirm that both the infrastructure and operational policies are consistent with acceptable anesthesia practice standards before providing anesthesia in such settings.
In general, ambulatory procedures should be of a complexity and duration such that one could reasonably assume that the patient will make an expeditious recovery and not require post-procedure hospital admission.
Factors considered in selecting patients for ambulatory procedures include systemic illnesses and their current management, airway management problems, sleep apnea, morbid obesity, previous adverse anesthesia outcomes (eg, malignant hyperthermia), allergies, and the patient’s social network (eg, availability of someone to be responsive to the patient for 24 h).
++
Outpatient/ambulatory anesthesia is the subspecialty of anesthesiology that deals with the preoperative, intraoperative, and postoperative anesthetic care of patients undergoing elective, same-day surgical procedures. Patients undergoing ambulatory surgery rarely require admission to a hospital and are fit enough to be discharged from the surgical facility less than 24 hours after the procedure.
++
Non–operating room anesthesia (NORA; also referred to as out of the operating room anesthesia) encompasses both inpatients and ambulatory surgery patients who undergo anesthesia in settings outside of a traditional operating room. These patients can vary greatly, ranging from claustrophobic individuals in need of anesthesia for magnetic resonance imaging (MRI) procedures to critically ill septic patients undergoing endoscopic retrograde cholangiopancreatography in the endoscopy suite. NORA requires the anesthesia provider to work in remote locations in a hospital, where ease of access to the patient and anesthesia equipment may both be limited; furthermore, the support staff at these locations may be unfamiliar with the requirements for safe anesthetic delivery.
++
Office-based anesthesia refers to the delivery of anesthesia in a practitioner’s office that has a procedural suite incorporated into its design. Office-based anesthesia is frequently administered to patients undergoing cosmetic surgery or dental procedures.
++
Although anesthetic techniques may be similar for inpatients, ambulatory surgery center patients, out of the operating room patients, and office-based anesthesia patients, these patients have differing needs. Thus, there are guidelines and statements from the American Society of Anesthesiologists (ASA) that pertain to these different locations. All of these recommendations should be reviewed at the ASA website (www.asahq.org/For-Healthcare-Professionals/Standards-Guidelines-and-Statements.aspx), as they are subject to change and modification. Accreditation agencies, such as the Joint Commission (TJC), Accreditation Association for Ambulatory Healthcare, and American Association for the Accreditation of Ambulatory Surgical Facilities, engage in various inspections and reviews to ensure that facilities meet acceptable standards for the procedural services provided. Anesthesia providers should confirm that both the infrastructure and operational policies are consistent with acceptable anesthesia practice standards before providing anesthesia in such settings.
...