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- The office needs to be appropriately equipped and stocked to perform general anesthesia (Table 31-5: Equipment Needed for Safe Delivery of Office-Based Anesthesia). All equipment described in the ASA algorithm for management of the difficult airway should be present. Perioperative monitoring must adhere to the ASA standards for basic anesthetic monitoring.
- The office-based anesthesiologist should be prepared to begin the initial treatment of malignant hyperthermia, which requires having at least 12 bottles of dantrolene (www.mahus.org).
- Drug accounting must be performed in accordance with state and federal regulations.
- A medical director who is responsible for overall operations should be identified for every office. There should always be at least one member of the health care team with Advanced Cardiovascular Life Support or Pediatric Advanced Life Support certification present in the office.
- Emergencies can occur in an office-based setting (Table 31-6: Emergencies that may Occur within an Office that Require Contingency Plans). Destinations for a patient in need of hospital admission must be identified with a formal written arrangement with a nearby hospital. Contingency plans must be in place in the event of a power supply interruption or electrical failure.
- Accreditation (Table 31-7: American Society of Anesthesiologists' Classification of Surgical Offices According to the Anesthesia and Surgical Procedures Performed and Table 31-8: Factors Considered by Accrediting Agencies). The actual improvement in safety conferred by performing surgery in an accredited office has yet to be determined, and as long as there is no mandatory reporting system in place, it will be impossible to determine true morbidity rates associated with an office-based practice.
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