Safety in office-based anesthesia: an updated review of the literature from 2016 to 2019

Abstract

Purpose of review Office-based anesthesia (OBA) is rapidly growing across the world. Availability of less invasive interventions has facilitated the opportunity of offering new procedures in office-based settings to patient populations that would not have been considered in the past. This article provides a practical approach to discuss and analyze newest literature supporting different practices in the field of OBA. In addition, an update of the most recent guidelines and practice management directives is included. Recent findings Selected procedures may be performed in the office-based scenario with exceedingly low complication rates, when the right patient population is selected, and adequate safety protocols are followed. Current regulations are focused on reducing surgical risk through the implementation of patient safety protocols and practice standardization. Strategies include cognitive aids for emergencies, safety checklists, facility accreditation standards among other. Summary New evidence exists supporting procedures in the office-based scenario in areas such as plastic and cosmetic surgery, dental and oral surgery, ophthalmology, endovascular procedures and otolaryngology. Different systematic approaches have been developed (guidelines and position statements) to promote standardization of safe practices through emergency protocols, safety checklists, medication management and surgical risk reduction. New regulations and accreditation measures have been developed to homogenize practice and promote high safety standards.

Complications and Solutions for Post-Operative Liposuction Deformities

“…The lowest fatality rates are reported with "true" tumescent liposuction in which general anesthesia is not used. Complication rates are decreasing as new technologies emerge, for example, laser liposuction [8]. Gupta et al reviewed procedures across several accredited facilities and found evidence that in-office procedures are a very safe alternative when adequate patient selection is used.…”

Office-based anesthesia: a contemporary update on outcomes, incentives, and controversies

“…Previous reviews over the past ten years showed emerging trends towards patient safety in the office-based surgical (OBS) centers and ambulatory surgery centers (ASC) [1][2][3][4][5]. Common OBS procedures at that time included abdominoplasty, orthopedic surgery, plastic surgery, pain management procedures, and dental surgery, with infrequent complications like venous thromboembolism (VTE), hospital admissions, and rarely, death [1,5].…”

Emergencies in freestanding ambulatory surgery centre

“…More procedures and increasing number of patients are today undergoing surgical and diagnostic interventions in freestanding ambulatory surgical units [1]. There is an increasing interest not only in moving procedures to ambulatory surgical centres but also further into office-based surgery [2 ▪ ,3 ▪ ] (Fig. 1).…”