by Derek Sakata, MD, and Patrick Bakke, MD

Anesthesia is Easy!

When working with our students, I half kiddingly say, “One only needs to accomplish four goals to become a safe and board-certified anesthetist.”

After absorbing their hopeful but quizzical expressions, I state that everything they do is about protecting the patient. First, protect the patient from the surgeon/proceduralist. Although the patient is receiving therapeutic care, we all know there are any number of risks associated with the procedure. Second, protect the patient from us, the anesthetist. We all know that any one of our medications can cause patient demise if dosed incorrectly and combinations of medications can have even more acute deleterious effects. Third, protect the patient from themselves. All of us have experienced patients with such severe comorbidities that they run the risk of acute deterioration in pre-op before they even receive medications from us or undergo the procedure! The fourth is ascertaining their risks with each of the three and then the combination of these.  Upon recitation of this fourth goal, the countenances of my enthusiastic protégés become a bit more flummoxed.

Your Island

As many of us practicing anesthetists know, there is a balance between what types of cases we do, what types of patients qualify and the combination of both of these together.

Balancing these goals is particularly important for ambulatory surgery centers (ASC) in which a majority, if not all, of the cases are elective and the centers are usually devoid of advanced resources to care for the complex maladies of some challenging patient populations.  Additionally, these maladies may be pre-existing and/or explode when fanned by the insults associated with our procedures and/or our anesthetic management.

It is in consideration of these issues, our Senior Nursing Ambulatory Surgery Director, Selena Young, MBA, BSN, RN, CASC explains, “In ambulatory surgery centers, we are not there to diagnose issues during surgery. The diagnosis should already have been made and we are there to treat.” 

Our Surgical Services Nurse Manager Brent Klev, MBA, BSN, RN, summarizes, “When faced with medically complex patients, sometimes you just don’t let them on your island.” 

I like both of these statements because they generally dictate not only how we discern which patients we choose but also how we decide on their treatment. 

Welcome to ASC Island

Many, if not all of us, are challenged by what patients to allow in our ASCs. Top of mind are, of course, airway and respiration and having necessary knowledge, ability and resources to handle routine and emergency issues in the care of our patients. At the University of Utah, we have come up with evidence-based guidelines to guide our decisions in selecting and caring for our ASC patients.  Specifically, we have come up with body mass index inclusion metrics and pediatric guidelines.

In our Ophthalmic Anesthesia Society (OAS) board discussions, we have discussed the benefits of sharing our evidence-based guidelines that many of us have written to create discussion and generate consensus on what patients we specifically think can be safely cared for in our centers.  We look forward to increased and ongoing dialogue and collaboration to optimally and more uniformly care for all of our patients. Aloha and Mahalo!

Are there any evidence-based guidelines you'd like to share? Add them to the comments below!