Injuries and deaths occurring in offices are often multifactorial in their causation (including overdosages of local anesthetics, prolonged surgery with occult blood loss, accumulation of multiple anesthetics, hypovolemia, arterial hypoxemia, and the use of reversal drugs with short half-lives).

1. Both the Anesthesia Patient Safety Foundation and the American Society of Anesthesiologists ( ASA) have emerged as leaders in the field of OBA safety and have advocated that the quality of care in an office-based practice be no less than that of a hospital or ASC.
2. Reports of morbidity and mortality within office-based practices vary dramatically.
   1. The challenge of acquiring accurate morbidity and mortality data for OBA is complicated by the fact that many offices are not required to report adverse events.
   2. There are reported cases of injuries to patients in offices resulting from obsolete and malfunctioning anesthesia machines, as well as resulting from alarms that have not been serviced or are not functioning properly (Table 31-2: Causes of Injury in the Office). The ASA has created guidelines for defining obsolete anesthesia machines.

Office-Based Anesthesia

1. Brief Historical Perspective of Office-Based Anesthesia
2. Advantages and Disadvantages
3. Office Safety
4. Patient Selection
5. Surgeon Selection
6. Office Selection and Requirements
7. Procedure Selection
8. Anesthetic Techniques
9. Postanesthesia Care Unit (PACU)
10. Regulations
11. Business and Legal Aspects
12. Conclusions