Doctors are doing more than just checkups in their offices
these days. Advances in medical technology have made it
possible for physicians to perform more advanced and more
complex surgical procedures in their offices.
Whether it's a tummy-tuck or a biopsy, every surgical procedure
performed in a doctor's office involves some form of analgesia
or anesthesia to make the surgery painless. Some office-based
procedures might even involve general anesthesia that provides
total loss of consciousness.
Office-based surgeries can be very different from surgeries
performed in a conventional hospital or ambulatory surgical
center. If you or a family member plans to have surgery
in a physician's office, you should know what to expect
and what questions you should ask in advance. This brochure
will help you to be more informed about office-based anesthesia
and surgery.
What is office-based anesthesia?
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There are three places where anesthesia is administered
for surgery:
- in a hospital or medical center,
- in an ambulatory surgical center or
- in a doctor's office.
Sometimes called ambulatory anesthesia, special medications
and techniques are used when a patient is expected to go
home as soon as possible on the same day of the surgery.
Office-based surgery, thus, is a form of ambulatory anesthesia.
Since most patients want to avoid an overnight hospital
stay after surgery, ambulatory surgical procedures have
become very popular. That's why almost one-half of all surgeries
are now being done in an outpatient facility, either connected
to a hospital or in a separate surgical center. More recently,
though, there has been a growing trend for surgery to be
done right in a doctor's office. Office-based surgery can
offer the convenience of having a procedure done in a more
comfortable setting and with a quick return home.
The same anesthetic techniques used in hospitals and ambulatory
surgical centers are used in office-based surgery. They
include:
- Local Anesthesia, which provides numbness to
a small area of the body, such as a dermatologist might
use to numb the skin around a mole before removing it.
- Monitored Anesthesia, (Sedation/Analgesia), during
which a patient receives medications that relieve pain
and make the patient drowsy. During surgery, the patient's
vital signs, including heart rate, blood pressure and
oxygen level, will be watched closely in order to avoid
sudden changes or complications.
- Regional Anesthesia, which can include spinal
blocks, epidural blocks or extremity blocks. Spinal and
epidural blocks involve interrupting sensation from the
legs or abdomen by injecting local anesthetic medication
in or near the spinal canal. Other blocks can be performed
for surgery on your extremities, or limbs, blocking sensations
from the arm or leg.
- General Anesthesia, which involves the total
loss of consciousness, pain sensation and protective airway
responses.
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Patients undergoing office-based procedures will be asked
to follow precautions similar to those in a hospital or
an ambulatory surgical center. For example, patients may
be asked to not eat or drink anything for several hours
before the surgery, and they may be advised to arrange for
a responsible adult relative or friend to drive them home
after surgery.
What kinds of surgical procedures are being performed
in physicians' offices?
From the simple removal of a mole to breast augmentation/reduction,
liposuction, hernia repairs or knee arthroscopies, a rapidly
growing number of surgeries are being performed in doctors'
offices rather than in hospitals or ambulatory surgical
centers. More complex procedures are likely to become common
in the near future.
How common is office-based surgery?
If you have surgery in a doctor's office, you certainly
will not be alone. By the year 2005, an estimated 10 million
procedures will be performed annually in doctors' offices
- twice the number of office-based surgeries performed in
1995.
Although 70 percent of surgeries are currently performed
in hospitals or ambulatory surgical centers, the trend toward
office-based surgery is growing at least as fast as the
trend toward ambulatory surgery grew a few years ago. Today,
about one out of 10 surgeries are performed in a doctor's
office.
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What makes office-based anesthesia different?
There is one fundamental and very important difference
between office-based anesthesia and receiving anesthesia
in a hospital or surgical center: The strict, well-defined
standards and regulations that help keep surgery and anesthesia
very safe in hospitals and surgical centers do not uniformly
apply to physicians' offices in the United States.
Currently, only a few states and the District of Columbia
require the same standards and regulations in doctors' offices
as they do in hospitals and surgical centers. Without minimum
safety standards, however, there is a chance that office-based
surgery may be taking place in environments with limited
or outdated equipment, few or no emergency resources, inadequately
trained staff or insufficient safety precautions.
This absence of standards and regulations, however, does
not mean that the medical community is ignoring the needs
of patients. In fact, the American Society of Anesthesiologists
(ASA) has developed comprehensive guidelines for office-based
anesthesia and is urging states to adopt these same guidelines
as regulations to protect all patients.
During the past 20 years, anesthesia-related deaths have
dropped dramatically from one in 10,000 anesthetics delivered
to one in 400,000 for outpatient procedures, due to the
constant efforts of anesthesiologists to make patient safety
their highest priority. Today, more than 90 percent of all
anesthetics in hospitals and ambulatory surgical centers
are directly administered or medically supervised by anesthesiologists.
Anesthesiologists are also actively involved in designing
guidelines and regulations to ensure patient safety in office
surgery situations.
In considering your options when surgery is advised, here
are some questions you should ask before undergoing surgery
in a doctor's office:
Who will be providing my anesthesia, and has this person
been trained to give anesthesia?
Ideally, anesthesia should be delivered or supervised by
an anesthesiologist who, as a physician, is medically trained
to evaluate your health needs, decide whether you are a
good candidate for surgery in an office setting and then
determine what medications are best for you before, during
and after surgery. At a minimum, a person extensively trained
in the delivery of anesthesia should be involved. If that
person is not a physician, then a physician should directly
supervise your anesthesia care. You will have the opportunity
to talk with the person giving you your anesthesia on the
day of your surgery.
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What kind of anesthesia will I receive?
Your anesthesia needs are determined by your medical condition
as well as by the type of operation you will have. Your
anesthesiologist will discuss your anesthetic care with
you before the surgery.
How long is the surgery expected to last?
This depends mostly on the nature of the surgery and is
best answered by your surgeon.
How will I be monitored during the surgery, and by whom?
Blood pressure, pulse rate, EKG and oxygen levels are some
of the important vital signs that the anesthesiologist monitors
during your surgery. If an anesthesiologist is not involved,
there should be a qualified individual monitoring your vital
signs.
What emergency procedures are in place in case there's
a serious complication?
A doctor's office should have the necessary emergency drugs,
equipment and procedures in place to care for you in the
rare event of a life-threatening complication. Anesthesiologists
have the specialized medical training to anticipate and
treat anesthesia-related complications. In rare instances,
serious complications may require that you are transferred
to a local hospital.
Who will monitor my recovery after the surgery, and
for how long? According to the guidelines of the American
Society of Anesthesiologists, all phases of anesthesia,
including recovery, should be supervised by a physician.
Many doctors' offices have experienced nurses to assist
you in your recovery. Personnel with training in advanced
resuscitation techniques should stay in the office until
you are discharged.
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Would the surgeon be permitted to perform this same
surgery in a hospital?
These guidelines also state that doctors should perform
only those surgeries in their offices that they are qualified
to perform in a hospital.
Are doctors' offices licensed or accredited to do surgery?
Many states require licensing or accreditation by a recognized
agency. These agencies regularly inspect such offices to
ensure that minimum standards of patient are met. Ask your
doctor if his or her surgical office has been accredited.
Be an Informed Consumer!
There may be times when a person is not a good candidate
to have surgery in a doctor's office. For example, people
with severe chronic diseases like heart conditions, lung
problems or diabetes may be referred to a hospital or outpatient
surgical center where their specific medical conditions
can be managed better.
As with any health care matter, it helps to be informed
and aware before undergoing an office-based surgical procedure.
Office-based surgery can offer needed medical care in a
convenient, comfortable and affordable environment. It is
important that the patient be involved in the planning and
delivery of their care.
Obtaining answers to the above questions will help to assure
that you receive safe, high-quality care tailored to your
individual needs.
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"Office-Based Anesthesia and Surgery" has been
prepared by the American Society of Anesthesiologists through
the cooperative efforts of the Society's Committee on Communications
and the Committee on Ambulatory Surgical Care.
Copyright © 2001 by the American Society
of Anesthesiologists
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