April 2000
Volume 64 |
Number 4
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SUBSPECIALTY NEWS
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| SAMBA Ready for
Uncertain Future |
Richard A. Kemp, M.D., President
Society for Ambulatory Anesthesia
The widespread development of ambulatory anesthesia first began
in the late 1960s at the University of CaliforniaLos Angeles
and at George Washington University Hospitals. It was 30 years
ago that the first freestanding surgical facility emerged as the
Surgicenter in Phoenix. It created immediate interest nationwide
among physicians and insurance companies because surgery with
general anesthesia could now be done safely in a freestanding
setting away from the hospital.
Presently, a new surgical paradigm with enormous implication
for anesthesiologists is rapidly emerging. The practice of office-based
surgery is today where ambulatory surgery was 20 years ago, when
only 5 percent of anesthetics were administered for outpatients.
It is widely stated that upward of 10 million of the estimated
40 million anesthetics administered annually will be performed
in the office setting over the next five years.
Last year, the ASA Committee on Ambulatory Surgical Care prepared
a document titled "Guidelines for Office-Based Anesthesia." It
was accepted at the October 1999 meeting of the House of Delegates
and published in the January
2000 ASA NEWSLETTER. SAMBA members were instrumental
in helping the committee on Ambulatory Surgical Care develop this
important document.
These guidelines are some of the nation's most comprehensive
for office-based anesthesia care. They provide answers to questions
and concerns posed by anesthesiologists concerning office-based
surgery.
Medical licensing boards and regulatory agencies are becoming
involved. Several states have established policies and regulations,
notably California and New Jersey. More will be forthcoming, and
it is vital that anesthesiologists realize that expressing safety
and quality of care issues, while important, does not necessarily
outweigh the political issues.
Twenty or 30 years ago, there was scant interest on the part
of most anesthesiologists to become involved with a freestanding
practice. However, since upward of 25 percent of all surgery may
be done in an office setting in the near future, it will be important
for anesthesia groups, both private practice and academic, to
pursue this as an important public service as well as an entrepreneurial
opportunity.
Research in the past few years has centered on a number of important
issues. The best methods of evaluating patients prior to surgery
has received widespread interest. The "big little problem" of
postoperative nausea and vomiting has stimulated discussion and
numerous papers. Various protocols for controlling postoperative
pain have stimulated increased awareness for recovering surgical
patients.
Other prominent papers have dealt with fast-tracking of patients
-- a response to cost-containment related to managed care pressures.
Similarly, the cost of anesthesia drugs and techniques, along
with paradigms for operating room scheduling, continues to evoke
interest. Future research and programs will likely focus on the
Internet. Programs are being developed for obtaining the data
on preoperative evaluations from physicians' offices and clinics
over the Internet. Finding and using Internet resources for anesthesiologists
is receiving greater interest. The Society for Ambulatory Anesthesia
(SAMBA) now has a Web site
that has patient information and has been receiving a large volume
of "hits."
SAMBA is currently processing applications for a major grant
award to fund a study for anesthetic outcome. Hopefully, that
this will stimulate further research that will have serious implications
for health care policy.
Ambulatory anesthesia and surgery are now in the political arena
and will provide new challenges and opportunities.
Yet SAMBA's mission remains the same as when it was founded
in 1985. Its mission is to contribute to the growth and influence
of the Society, to encourage specialization in the field of ambulatory
anesthesia and to encourage high ethical and professional standards
by fostering and encouraging research, education and scientific
progress in the subspecialty.
ASA members are invited to learn more about this dynamic organization,
with nearly 5,000 practitioners across the country and throughout
the world, by visiting the SAMBA Web site to see for themselves
the many benefits and services the Society has to offer those
now involved in ambulatory anesthesia or those looking to expand
their practice into this growing subspeciality, be it in a hospital
outpatient setting, a freestanding surgical center or an office-based
practice.
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