1. Before presenting for an office-based procedure, the patient must be medically optimized. The patient should have a preoperative history and physical examination recorded within 30 days, all pertinent laboratory tests performed, and any medically indicated specialist consultation(s) done.
   1. Patient selection for OBA is a controversial topic. The ideal patient for an office-based procedure has an ASA physical status of 1 or 2. The ASA also has developed recommendations regarding patient selection.
   2. When determining whether a patient is suitable for OBA, it is important to realize that the location is often remote and the anesthesiologist may be unable to get assistance if it is required. Therefore, anticipated anesthetic problems must be avoided (Table 31-3: Characteristics of Patients Who May not be Good Candidates for Office-Based Procedures).
2. Obesity and Obstructive Sleep Apnea. It is estimated that 60% to 90% of all patients with obstructive sleep apnea (OSA) are obese. The majority of the patients with OSA have not been formally diagnosed. There may be failure to intubate the trachea or ventilate the lungs, they may have respiratory distress soon after tracheal extubation, or they may experience respiratory arrest with preoperative sedation or postoperative analgesia. These patients tend to be exquisitely sensitive to the respiratory depressant effects of even small dosages of sedation or analgesics.
3. Pulmonary embolism from deep vein thrombosis is a significant cause of perioperative morbidity and mortality from office-based surgical procedures.

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