Office-based Anesthesia: Successes and Challenges

R. Twersky, Saad Mohammad
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引用次数: 1

Abstract

O ffice-based surgery (OBS) accounted for 10 million of all elective procedures performed in the United States in 2005 and has doubled since 1995. Although there are no good national registries to accurately determine the number of surgical procedures occurring in offices, the projections have ranged from 17 to 24% of all elective ambulatory surgery procedures. This phenomenon has paralleled, and was certainly driven by, the huge increase in demand for cosmetic surgery over the past 10 years. Newer surgical and anesthetic techniques have allowed more invasive procedures to be performed in nonhospital settings. Economic advantages and physician and patient convenience have fueled the rapid growth of OBS and office-based anesthesia (OBA). Other advantages of OBS include ease of scheduling, greater privacy, lower cost, no risk for nosocomial infection, increased efficiency, and consistency in nursing personnel (Supplemental Digital Content 1, http:// links.lww.com/ASA/A302). Despite these advantages, OBS is not embraced by all surgeons nor is it appropriate for every patient or surgical procedure. In addition, OBA requires a different approach than that used in hospitals and ambulatory surgery centers. The rapid growth of OBA has not been uniformly accompanied by adherence to safety standards followed in hospitals or ambulatory surgery centers. The current status of OBA and challenges faced by office-based anesthesiologists regarding patient safety, patient and procedure selection, and anesthesia management for adult patients are the subject of this chapter.
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办公室麻醉:成功与挑战
2005年,在美国进行的所有选择性手术中,办公室手术(OBS)占了1000万例,自1995年以来翻了一番。虽然没有良好的国家登记来准确确定在办公室进行的外科手术的数量,但预测范围从所有选择性门诊手术的17%到24%不等。这一现象与过去10年整容手术需求的巨大增长是并行的,当然也是受其推动的。较新的外科和麻醉技术已经允许在非医院环境中进行更具侵入性的手术。经济优势和医患便利推动了OBS和办公室麻醉(OBA)的快速发展。OBS的其他优点还包括易于调度、更大的隐私性、更低的成本、无医院感染风险、提高效率和护理人员的一致性(补充数字内容1,http:// links.lww.com/ASA/A302)。尽管有这些优点,OBS并不是所有的外科医生都接受,也不适合每个病人或手术过程。此外,OBA需要一种不同于医院和流动手术中心使用的方法。医院或门诊手术中心的安全标准并没有得到严格遵守,而门诊手术的快速增长也没有得到统一的遵循。本章的主题是OBA的现状以及办公室麻醉师在患者安全、患者和手术程序选择以及成人患者麻醉管理方面面临的挑战。
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