Questions

Safety | Administer sedation | Monitor | Side Effects | Patients Expect | Intravenous | Conscious

Is Office Anesthesia Safe?

Due to improvements in drugs, technology, anesthesia techniques, and provider education, anesthesia care is safer than it has ever been. In fact, the Institute of Medicine reported in 1999 that anesthesia is nearly 50 times safer today than it was in the early 1980's.

The same standard of anesthesia care for hospitals and Ambulatory Care Facilities also applies to office settings, regardless of whether the anesthesia professional is a CRNA or an anesthesiologist.

The first and most comprehensive "Standards for Office Based Anesthesia Practice" were developed by the American Association of Nurse Anesthetists (AANA) and adopted in 1999. They can be viewed at:

www.aana.com/crna/prof/obstandards.html

In addition, many states have adopted laws, regulations, or guidelines concerning office surgery and anesthesia practices as the demand for these services grows.

Partners in Safety—You and Your Anesthetist

How can you find out if an office truly is safe for surgery and anesthesia? By becoming a partner in safety with your CRNA. Patients who know what to look for in the office setting and what questions to ask their CRNA can better determine how safe a facility is.

Safe-Office Necessities*

  • Well-defined patient selection guidelines (because not everyone is a candidate for office surgery/anesthesia)
  • Monitoring equipment with a backup electrical source
  • Ability to treat problems and emergencies
  • Plans for transferring patients to other healthcare facilities if necessary
  • A sterile environment, including strictly enforced guidelines for hand washing and equipment use
  • Minimal testing before the procedure, including required consultations
  • Routine equipment maintenance
  • Clearly defined procedures for patient recovery and discharge
  • Procedures for follow-up care
  • Are you a Certified Registered Nurse Anesthetist?
  • Do you regularly provide anesthesia care in office settings? Have you worked in this particular office before?
  • Will you stay with me throughout my surgery?
  • Will you perform a thorough and complete pre anesthesia assessment prior to my surgery?
  • Will you develop a care plan for my anesthesia care based on the assessment and other information?
  • If I am considered to be a questionable or inappropriate patient for office surgery and anesthesia, will I be informed of this?
  • Will I be left alone at any time following my procedure while I am still a patient in the facility?
  • What precautions will be taken to minimize my risk of infection?
  • Will you develop a plan to safely manage any pain I experience after surgery?



WHEN is sedation administered?

Sedation is administered in hospitals, outpatient facilities, e.g., ambulatory surgery centers, doctors offices, dental offices, etc., to facilitate procedures such as the following:
  • Breast biopsy
  • Vasectomy
  • Minor foot surgery
  • Minor bone fracture repair
  • Plastic/reconstructive surgery
  • Dental prosthetic/reconstructive surgery
  • Endoscopy (example: diagnostic studies and treatment of stomach, colon and bladder)
  • Routine dental work
  • Dental work for “special needs” patients



WHO CAN ADMINISTER sedation?

Sedation is extremely safe when administered by qualified providers. Certified Registered Nurse Anesthetists (CRNA's), anesthesiologists, some other physicians, dentists, and oral surgeons are qualified providers of conscious sedation. Specifically trained registered nurses may assist in the administration of conscious sedation. Precept Anesthesia Services contracts only with Masters prepared CRNA are with excellent references, who maintain continuous certification and full clinical privileges.



WHO SHOULD MONITOR sedation?

Because patients can slip into a deep sleep, proper monitoring of conscious sedation is necessary. Healthcare providers monitor patient heart rate, blood pressure, breathing, oxygen level, carbon dioxide exhalation, and alertness throughout and after the procedure. The provider who monitors the patient receiving conscious sedation should have no other responsibilities during the procedure and should remain with the patient at all times during the procedure.

The level of sedation will be determined by the nature of your operative procedure.

Some procedures require only minimal to moderate sedation. Others will require a deeper level. Your anesthetist will determine the appropriate level of sedation for your particular procedure. This will be discussed on the phone for your pre-operative interview.



What are the SIDE EFFECTS of sedation?

A brief period of amnesia after the procedure may follow the administration of sedation. Occasional side effects include headache, hangover, nausea and vomiting or unpleasant memories of the surgical experience. Medications will be administered to prevent side effects, to the extent that they can be controlled. You may also receive prescriptions from your doctor for post-procedure comfort.



What should PATIENTS EXPECT immediately following the procedure?

A qualified provider monitors the patient immediately following the procedure. Written postoperative care instructions should be given to the patient to take home. Patients should not drive a vehicle, operate dangerous equipment or make any important decisions for at least 24 hours after receiving conscious sedation. A follow-up phone call usually is made by the healthcare provider to check on the patient's condition and answer any remaining questions.

What is the ROLE OF THE CAREGIVER after the anesthesia?
The person caring for an individual post Intravenous Sedation must be alert to the possibilities of oversedation, drowsiness, unsteady gait, low blood sugar, faulty reasoning and decision making in the patient. The caregiver must check on the patient every 10-15 minutes for approximately two hours. During this time the patient needs assistance in usual, routine activities. Medications should be noted on a pad of paper as to the time and amount taken. Talking on the phone is usually not a good idea after sedation.



What is intravenous sedation?

What Patients Should Expect
Sedation provides a safe and effective option for patients undergoing minor surgeries, dental work, or diagnostic procedures. The number and type of procedures that can be performed using intravenous sedation have increased significantly as a result of new technology and state of the art medications. conscious sedation allows patients to recover quickly and resume normal activities in a short period of time.

QUESTIONS to ask about intravenous sedation
The following is a list of questions that patients should ask prior to the surgical or diagnostic procedure:
  • Will a trained and skilled provider be dedicated to monitoring me during conscious sedation?
  • Will my provider monitor my breathing, heart rate, and blood pressure?
  • Will oxygen be available and will the oxygen content of my blood be monitored?
  • Are personnel trained to perform advanced cardiac life support?
  • Is emergency resuscitation equipment available on-site and immediately accessible in the event of an emergency?
  • Will a trained and skilled provider stay with me during my recovery period and for how long?
  • Should a friend or family member take me home?



What is CONSCIOUS SEDATION?

This type of sedation induces an altered state of consciousness that minimizes pain and discomfort through the use of pain relievers and sedatives. Patients, who receive conscious sedation usually are able to speak and respond to verbal cues throughout the procedure, communicating any discomfort they experience to the provider. Other types of sedation (see below) produce a deeper level of unconsciousness. A brief period of amnesia may erase any memory of the procedure.



Are there other LEVELS OF SEDATION?

The depth of sedation can range from minimal to deep sedation.

Minimal sedation (anxiolysis):
A drug-induced state during which patients respond normally to verbal commands. Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected.

Moderate Sedation/analgesia (conscious sedation):
A drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.

Deep Sedation/analgesia:
A drug-induced depression of consciousness during which patients cannot be easily aroused, but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.

Anesthesia:
Consists of general anesthesia and spinal or regional anesthesia. It does not include local anesthesia. General anesthesia is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.