Office-based Anesthesia Research Articles

Twelfth Annual Meeting of the Society for Pediatric Anesthesia, Orlando, Florida, October 16, 1998

Twelfth Annual Meeting of the Society for Pediatric Anesthesia, Orlando, Florida, October 16, 1998

MEDICOLEGAL CONSIDERATIONS FOR OFFICE-BASED ANESTHESIA IN DENTISTRY

Over the past decade, there has been a virtual explosion in the demand and utilization of office-based ambulatory anesthesia services in dentistry. Not surprisingly, with this increased demand has come an increased exposure to medicolegal risks and concerns for the unwary or unprepared dental practitioner. This article provides the practitioner with a brief overview of the potential medicolegal risks and recent trends in litigation that may arise in today's office-based anesthesia practice.

Office-based surgery and anesthesia: where are we now?

At the time of publication of this journal, the Center for Urinary Control in Memphis, Tennessee, has performed eight office-based surgical procedures using anesthesia. Patients were aged between 56 and 80 years, and all were ASA I-III class. The procedures involved either cystoscopy with collagen injection into the bladder neck or cystoscopy with indigo laser treatment of the prostate. All patients were prepared by the anesthesiologist prior to the day of surgery, and appropriate laboratory tests were ordered and evaluated. All patients did very well, the surgical field was quiet, and each procedure went very smoothly. Each patient tolerated anesthesia without any adverse effect, was recovered in an adjacent examination room, and was extremely satisfied upon discharge from the office. Anesthesia was induced with Propofol (Diprivan) and sublimaze, maintained with a Propofol infusion and oxygen. The surgeon performed a periprostatic block on the patient having the Indigo laser treatment.

Office-based anaesthesia

Office-based anaesthesia is a young but rapidly growing speciality practice. In patient selection, surgical procedures, and anaesthetic techniques this practice is similar to standard ambulatory surgery; however, the liability and risks of office-based anaesthesia are greater. The anaesthesiologist's major challenge is to insist on patient safety in this developing field.

Office-based anaesthesia: the UK perspective

Although office-based anaesthesia is not prevalent in the United Kingdom, anaesthesia has long been provided in community dental surgeries. Because of concerns over the safety of providing anaesthesia in hazardous remote locations, several expert working parties have examined UK dental anaesthesia and made numerous recommendations for safe practice. Concerning training, general anaesthesia, sedation, equipment, monitoring, resuscitation and building layout, these recommendations provide an excellent basis for local, regional or national guidelines for many forms of office-based anaesthesia. Putting the recommendations into practice, however, has had a fundamental impact on the provision of UK dental anaesthetic services and may have significant cost implications. These aspects should be carefully considered by anyone involved with planning or delivering office-based anaesthesia.

Anaesthesia for paediatric office-based surgery

General considerations for providing office-based anaesthesia to children are reviewed. These include monitoring and equipment, preoperative considerations, anaesthetic technique, emergence and recovery, and economic issues. Specific considerations for the haematology/oncology, gastroenterology, orthopaedic, dental and ophthalmologic clinics are also reviewed.

The history of office-based anesthesia

The history and evolution of office-based anesthesia are described, with particular emphasis on the role of the dental anesthesia community in the development of this style of practice.