The American Society of Anesthesiologists (ASA) have issued a set of guidelines for office based anesthesia that focus on the issue of safety and quality. While they are clear to state that following these guidelines cannot guarantee a good outcome, it is an important step that the ASA has taken as advocates for patient safety.

The ASA also states that the existing "Guidelines for Ambulatory Anesthesia and Surgery" and other guidelines should still be followed - this is a logical statement since office-based anesthesia is a subset of all anesthesia practice and specifically of ambulatory anesthesia practice.

In general the ASA states that the anesthesiologist "must satisfactorily investigate areas taken for granted in the hospital or ambulatory surgical facility such as governance, organization, construction and equipment, as well as policies and procedures, including fire, safety, drugs, emergencies, staffing, training and unanticipated patient transfers" and "should be confident ... issues are addressed in an office setting to provide patient safety and to reduce risk and liability to the anesthesiologist".

Here are some of the more important parts of the policy (in my opinion) quoted directly from the ASA publication. (Remember that you can read the entire policy at the American Society of Anesthesiologists Website. Specifically, the policy is available in the "Standards and Guidelines" section).

• Policies and procedures should be written for the orderly conduct of the facility and reviewed on an annual basis. The medical director or governing body should ensure that all applicable local, state and federal regulations are observed.
• All health care practitioners* and nurses should hold a valid license or certificate to perform their assigned duties.
• All operating room personnel who provide clinical care in the office should be qualified to perform services commensurate with appropriate levels of education, training and experience.
• The anesthesiologist should be satisfied that the procedure to be undertaken is within the scope of practice of the health care practitioners and the capabilities of the facility.
• The anesthesiologist should adhere to the "Basic Standards for Pre-anesthesia Care," "Standards for Basic Anesthetic Monitoring," "Standards for Post-anesthesia Care" and "Guidelines for Ambulatory Anesthesia and Surgery" as currently promulgated by the American Society of Anesthesiologists.
• The anesthesiologist should be physically present during the intraoperative period and immediately available until the patient has been discharged from anesthesia care.
• Discharge of the patient is a physician responsibility. This decision should be documented in the medical record.
• Personnel with training in advanced resuscitative techniques (e.g., ACLS, PALS) should be immediately available until all patients are discharged home.
• At a minimum, all facilities should have a reliable source of oxygen, suction, resuscitation equipment and emergency drugs. Specific reference is made to the ASA "Guidelines for Nonoperating Room Anesthetizing Locations."
• All equipment should be maintained, tested and inspected according to the manufacturer's specifications.
• There should be written protocols for cardiopulmonary emergencies and other internal and external disasters such as fire.
• The facility should have a written protocol in place for the safe and timely transfer of patients to a prespecified alternate care facility when extended or emergency services are needed to protect the health or well-being of the patient.

Please note that this represents only a sampling of some of the more important statements in the guideline. It is reproduced here to give you an idea of some of the important issues that confront anesthesiologists who are giving anesthesia in an office based setting. Read the entire guideline if you want more complete information.

Clearly, patients should make sure that standards such as these are adhered to by their surgeon's office and by the anesthesiologist responsible for their care during their anesthesia and surgery in that office. Remember that in most states there are no laws requiring these standards, routine in hospitals, to be followed in the doctor's office. Surgery can be done successfully in the office - but don't put your health or life in danger. Accidents, problems and complications do happen - the important thing is to have the proper personnel, equipment and protocols to take care of these rare occurrences properly and in the most effective way.

Read on to find out about questions that patients should make sure to ask before their office based surgery...