At the 20th Annual Ambulatory Surgery Centers Conference in Chicago on Oct. 24, G-A Lawson-Boucher, MD, lieutenant commander in the United States Navy Medical Corps and a diplomate of the American Board of Anesthesiology, outlined ways for ambulatory anesthesiologists to shorten patients’ length of stay in the post-anesthesia care unit.
Dr. Lawson-Boucher discussed how hospitals have been trying to bully anesthesiologists into being reluctant to perform outpatient surgery based on safety. However, data show fewer day-of-surgery deaths for office-based and ambulatory surgery centers procedures than hospitals by a significant margin.
“The problem with contemporary medicine is that it’s contemporary,” he said. “The people who have colored my life showed me that by following the contemporary, you will never lead.”
By using innovative techniques and thinking outside of the box, ambulatory anesthesiologists can get their patient PACU stays under one hour and reduce post-operative anesthesia problems and risks, he said.
His fast track formula includes assessing respirations and instabilities, then sedation and ambulation.
Teamwork is crucial to successful anesthesia strategy, Dr. Lawson-Boucher said. Teamwork includes the surgeons, the pre-operative nurses, operating room staff and any day-of-surgery personnel working together and being on the same page. “We win the battle before the recovery room,” he said.
Pre-operative management is crucial to selecting the proper anesthetics for the patient and procedure. Things to look for in a patient history include any herbal drug or supplement use, exercise tolerance for heart stress, sleep apnea, obesity, fibromyalgia, arthritis, past opioid dependency and a history of post-operative nausea or vomiting.
However, patients who fit into any risk categories should not be automatically sent to the hospital, he said. Anesthesiologists aware of all potential risks or complications can tailor drugs and monitoring to the patients’ specific needs.
“We are hyper vigilant,” Dr. Lawson-Boucher said. “Sending someone home pain free is not good enough. How will be they feel three, six, 12 hours later?”