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December 2001
Volume 65 |
Number 12
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SUBSPECIALTY
NEWS
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| Society for Ambulatory Anesthesia:
Moving On in Good Health |
J. Lance Lichtor, M.D., Immediate Past
President
Society for Ambulatory Anesthesia
In life, change is inevitable. In ambulatory surgery, change
has taken place for the betterment of patient care. The path,
though, has not been straight. The mission of the Society for
Ambulatory Anesthesia (SAMBA) is to advance the study and growth
of ambulatory anesthesia and to encourage high ethical and professional
standards by fostering and encouraging research, education and
scientific progress in ambulatory anesthesia.
From its very beginning, ambulatory anesthesia has pushed the
envelope. In 1842, Crawford W. Long, M.D., performed the first
ambulatory anesthetic on James Venable, removing a neck cyst.
In 1968, Wallace A. Reed, M.D., launched the Surgicenter, a freestanding
outpatient facility. As hospital length of stay declines, the
day might not be far off when virtually all surgery, except for
those patients who are critically ill, will be performed on an
ambulatory basis.
Change, however, does not come without a cost. Today, for instance,
as ambulatory or office-based surgery has become more popular,
surgeons do not feel the need to stay on the staff of hospitals.
Because of this, hospital-based emergency rooms are running out
of surgeons to call. An article in the June 3, 2001 Arizona Republic
highlighted several emergency rooms with this problem. In Tucson,
for example, there is no hand surgeon who takes calls in the emergency
room, so that patients with hand injuries must travel more than
100 miles to Phoenix.
In the medical literature, much has been written about both the
good and bad of individual outpatient procedures and trends in
this area. Much press has been given recently to liposuction surgery,
particularly concerning patients who have died. Appropriate patient
selection, appropriate perioperative patient monitoring (depending
on the extent of surgery) and appropriate prophylaxis against
pulmonary embolus apply to these and most other ambulatory procedures.
To examine on a larger scale the cost of change, SAMBA has funded
a $100,000 study to examine outcomes after ambulatory surgery.
Anesthesiologists, including ambulatory anesthesiologists, are
highly interested in the issue of postoperative pain. Postoperative
pain is one major factor that limits surgery from being considered
ambulatory surgery. One solution may be pain-controlling devices
that patients can take home. Regional anesthesia, for example,
might be continued postoperatively using an infusion of local
anesthesia through a catheter. Further study is necessary to identify
appropriate patients, type of pumps that can be used and appropriate
drugs.
SAMBA works to manage change. Each year, SAMBA runs two national
meetings to educate practitioners about pitfalls to avoid and
new techniques that can be used in ambulatory anesthesia. Our
fall meeting occurs on the Friday immediately prior to the ASA
Annual Meeting, and our major meeting occurs in the spring. Our
Web site <www.sambahq.org>
is designed to educate both the anesthesia caregiver and the lay
public about our specialty. Nonmedical individuals who do not
find the information they seek can send a note to the Society
through the Web page. If appropriate, the answer to that question
is then entered on the Web site. Because SAMBA wants to provide
information not only to people in the United States but also throughout
the world, the patient information portion of our site is translated
into Chinese, German and Spanish. Our monthly e-mail newsletter
and quarterly print newsletter are designed to continuously update
practitioners and the lay public about changes in the specialty.
Anyone can go to the Web site and sign up to receive the monthly
e-mail newsletter.
Most anesthesia practitioners practice ambulatory anesthesia
in some form. What then is the need for a separate society of
ambulatory anesthesia? The answer is that the field is changing
rapidly. Our efforts in both research and education are focused
on managing change. We provide a venue for practitioners of ambulatory
anesthesia to come together and think creatively. By anticipating
changes in health care, we can proactively make the growing practice
of ambulatory anesthesia more efficient and effective. Change?
Bring it on.
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J.
Lance Lichtor, M.D., is Professor, Department of Anesthesia,
University of Iowa, Iowa City, Iowa. |
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