Table Of ContentHandbook of Ambulatory
Anesthesia
Second Edition
Handbook of Ambulatory
Anesthesia
Second Edition
Rebecca S. Twersky, MD, MPH
Beverly K. Philip, MD
Editors
Editors
Rebecca S. Twersky, MD, MPH Beverly K. Philip, MD
Professor and Vice Chair for Research Professor of Anaesthesia
Department of Anesthesiology Harvard Medical School
SUNY Downstate Medical Center at Director, Day Surgery Unit
Brooklyn Brigham and Women’s Hospital
Medical Director—Ambulatory Surgery Boston, MA 02115 USA
Unit
Long Island College Hospital
Brooklyn, NY, 11203 USA
ISBN: 978-0-387-73328-9 e-ISBN: 978-0-387-73329-6
DOI: 10.1007/978-0-387-73329-6
Library of Congress Control Number: 2007930546
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and understanding families
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Preface
The practice of medicine has changed dramatically over the past quarter century.
These changes have often wedged physicians into situations in which clinical
practice is being shaped by the competing quest for optimum outcomes built
on evidence-based practice and the pressure of economic forces. Infl uenced by
the same factors, ambulatory surgery and anesthesia have also undergone major
changes, even since the Ambulatory Anesthesia Handbook (Mosby, 1995) was
fi rst published. Key examples are the number of surgical procedures that now
can be performed on an ambulatory basis due to improved surgical technology;
the exponential growth in the number of ambulatory surgery centers, particularly
in the U.S.; and advances in anesthesia with drugs that produce shorter emer-
gence and fewer postoperative adverse reactions, enabling more rapid patient
discharge. The health industry in the U.S. is at a crossroads, shifting to ambula-
tory surgery as the primary mode of surgical care. The number of ambulatory
surgery centers nears or surpasses the number of hospitals. This continued shift
is also apparent in the rapid growth of offi ce-based surgery. An increasing
number of complex procedures are moving from the inpatient to the outpatient
environment, out of hospital-based settings into freestanding ambulatory sur-
gery centers, and to physicians’ offi ces and diagnostic facilities. As ambulatory
surgery pushes to expand the scope of procedures and increase the quality of
care provided, anesthesia practices will continue to play a pivotal role. Addition-
ally, the push for patient-centered care and measurements of performance will
greatly infl uence the ways that hospitals, ambulatory surgery centers, offi ce-
based surgical practices, and their anesthesiologists approach patient selection,
sedation, anesthesia, pain management, and postoperative recovery.
It is no coincidence that this updated Ambulatory Anesthesia Handbook is
being published now. The intention of this handbook is to address the clinical
and administrative concerns that have arisen from the expanding daily practice
of ambulatory surgery and anesthesia. The handbook is directed to anesthesiolo-
gists both in training and in practice as well as other physicians, nurses, health
care professionals, ancillary providers, and administrators involved in the care
of ambulatory surgery patients. Practical approaches to the common problems
encountered in this continually growing fi eld, including recommendations and
guidelines for actual practice, are addressed. This book is intended to guide these
individuals through the steps of treating the ambulatory surgery patient.
The authors of this handbook are acknowledged and respected authorities
in the fi eld of ambulatory surgery and anesthesia and have elegantly provided
both state-of-the-art and cutting-edge information for clinical practice. Although
this book is multi-authored, we as editors have standardized the format for
each chapter, providing a brief outline with text materials accompanied by suc-
cinct illustrative and tabular enhancements and key references. The handbook
covers the spectrum of care, starting with preoperative evaluation (Chapter 1)
and anesthesia considerations for cutting-edge, minimally invasive ambulatory
surgery procedures (Chapter 2). Extensive discussions of the management of
common clinical conditions and considerations for the perioperative physician
viii Preface
for treating both adult and pediatric patients are provided (Chapters 3 and 4).
The preoperative preparation of pediatric and adult patients is covered in
Chapters 5 and 6, and specifi c anesthesia techniques—sedation, regional, and
general—are addressed in Chapters 7 through 9. Anesthesia outside the operat-
ing room (Chapter 10) and offi ce-based anesthesia (Chapter 11) are clearly
growing segments of clinical practice, and an especially in-depth discussion of
offi ce-based anesthesia practice is provided. The success of ambulatory anesthe-
sia is also measured in the safe recovery and discharge of the patient, as is
illustrated in Chapters 12 and 13. Quality measures, pay for performance, and
economic and administrative aspects are no less important than the anesthesia
techniques, and Chapters 14 through 16 provide an excellent overview for both
administrative and nonclinical management personnel. In keeping with the
format of a handbook, we have attempted to provide the most relevant and up-
to-date information; readers are referred to basic texts for more in-depth
discussions.
We sincerely acknowledge the scholarly efforts of all the contributing
authors, our colleagues in our respective departments, and the members of our
families, who appreciated the importance of this undertaking and permitted us
to dedicate our time and energy needed to complete this task.
Rebecca S. Twersky, MD, MPH
Beverly K. Philip, MD
Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Chapter 1 Preanesthesia evaluation and testing . . . . . . . . . . 1
L. Reuven Pasternak
Chapter 2 Minimally invasive and advanced ambulatory
procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Shireen Ahmad
Chapter 3 Adult clinical challenges . . . . . . . . . . . . . . . . . . . 47
Donald M. Mathews and Rebecca S. Twersky
Chapter 4 Pediatric clinical challenges . . . . . . . . . . . . . . . . 96
Lucinda L. Everett and Gennadiy Fuzaylov
Chapter 5 Pediatric perioperative management . . . . . . . . . . 115
Raafat S. Hannallah
Chapter 6 Adult preoperative preparation: equipment and
monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
J. Lance Lichtor
Chapter 7 Sedation techniques . . . . . . . . . . . . . . . . . . . . . . . 169
Tong J. Gan and Beverly K. Philip
Chapter 8 Regional anesthesia . . . . . . . . . . . . . . . . . . . . . . . 195
Holly C. L. Evans, Karen C. Nielsen,
and Susan M. Steele
Chapter 9 General anesthesia . . . . . . . . . . . . . . . . . . . . . . . . 234
Ralph Gertler and Girish P. Joshi
Chapter 10 Anesthesia outside the operating room . . . . . . . . 252
Steven C. Hall
Chapter 11 Offi ce-based anesthesia . . . . . . . . . . . . . . . . . . . . 283
Hector Vila, Jr., Meena S. Desai, and
Rafael V. Miguel
x Contents
Chapter 12 Postanesthesia care recovery and
management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Johnathan L. Pregler and Patricia A. Kapur
Chapter 13 Discharge process . . . . . . . . . . . . . . . . . . . . . . . . 354
Frances Chung and Jeremy Lermitte
Chapter 14 Quality management, regulation,
and accreditation . . . . . . . . . . . . . . . . . . . . . . . . . 371
Jerry A. Cohen, Sorin J. Brull,
and Walter G. Maurer
Chapter 15 Ambulatory surgery center profi tability,
effi ciency, and cost containment . . . . . . . . . . . . . 396
Tom Archer, Steve Mannis, and Alex Macario
Chapter 16 Administrative aspects of ambulatory
surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
William H. Beeson
Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467
Contributors
Shireen Ahmad, MD
Associate Professor, Department of Anesthesiology, Northwestern
University Feinberg School of Medicine, Chicago, IL, USA
Tom Archer, MD, MBA
Department of Anesthesiology, University of Texas Health Science
Center, San Antonio, TX, USA
William H. Beeson, MD
Medical Director, Beeson Aesthetic Surgery Institute, Clinical Profes-
sor, Departments of Dermatology and Otolaryngology, Indiana Univer-
sity School of Medicine, Carmel, IN, USA
Sorin J. Brull, MD
Professor of Anesthesiology, Mayo Clinic College of Medicine,
Jacksonville, FL, USA
Frances Chung, MD, FRCPC
University of Toronto, Toronto Western Hospital, Department of Anes-
thesia, University Health Network, Toronto, ON, Canada
Jerry A. Cohen, MS, MD
Associate Professor of Anesthesiology, University of Florida, College
of Medicine, Gainesville, FL, USA
Meena S. Desai, MD
President and CEO, Nova Anesthesia Professionals, Villanova, PA,
USA
Holly C. L. Evans, MD, FRCP(C)
Assistant Professor, Department of Anesthesiology, University of
Ottawa, Ottawa, ON, Canada
Lucinda L. Everett, MD
Chief, Pediatric Anesthesia, Associate Professor, Harvard Medical
School, Anesthesia and Critical Care, Massachusetts General Hospital,
Boston, MA, USA
