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Safety in office-based anesthesia

an updated review of the literature from 2016 to 2019

de Lima, Andresa; Osman, Brian M.b; Shapiro, Fred E.a

Current Opinion in Anesthesiology: December 2019 - Volume 32 - Issue 6 - p 749–755
doi: 10.1097/ACO.0000000000000794
AMBULATORY ANESTHESIA: Edited by Claude Meistelman
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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.

aDepartment of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

bDepartment of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Health System, University of Miami, Miller School of Medicine, Miami, Florida, USA

Correspondence to Fred E. Shapiro, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA. Tel: +1 617 667 3112; e-mail: fshapiro@bidmc.harvard.edu

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