1. Develop a difficult airway cart. Thomas Wherry, MD, medical director for Total Anesthesia Solutions and medical director for Health Inventures, says an ambulatory surgery center's first priority in improving airway management should be tasking anesthesiologists and nurse anesthetists with developing a difficult airway cart. This means researching each provider's preferred equipment and stocking the cart with those supplies. "I would highly recommend the center not buy anything [before checking with the anesthesiologist], because they wouldn't want to spend a lot of money on something only to find out the provider wants something else," he says.
He says the cart should include multiple sizes of LMAs, as well as some type of fiberoptic instrument. An ASA document, titled "Practice Guidelines for Management of the Difficult Airway" and available on the ASA website, suggests the cart carry rigid laryngoscope blades of alternate design and size, tracheal tubes of assorted sizes and fat least one device suitable for emergency noninvasive airway ventilation, among others.
From: 4 Tips on Difficult Airway Management
2. Take special precautions with children and the elderly. According to Raafat S. Hannahllah, MD, professor of anesthesiology and pediatrics at The George Washington University Medical Center, special precautions must be taken to ensure anesthesia safety in ambulatory surgery on infants, very young children and elderly patients. In a SAMBA report, Dr. Hannahllah said the key to success of pediatric ambulatory surgery lies in careful selection, screening and preparation of prospective patients. Physicians should consider a child's physical status, the type of surgery, the type of facility and the ability of staff to deal with complications. He added that general inhaled anesthetics are most popular for younger patients.
Kathryn E. McGoldrick, MD, professor and chair of anesthesiology at New York Medical College, said anesthesiologists are increasingly asked to care for older patients in the ambulatory setting. Appropriate reductions in drug dosage must be made for geriatric patients, and anesthesiologists should pay careful attention to proper selection and titration of drugs, she said. She added that postoperative analgesia is vitally important because of the association of pain with the development of postoperative delirium in the elderly.
From: Screening, Drug Reduction Essential for Ambulatory Surgery of Very Old and Very Young Patients
3. Use a checklist for antiobiotic administration. Organizations which use checklists to ensure proper and timely administering of antibiotics, and confirm a patient's condition and operation, at various stages of the patient surgical process including before the administering of anesthesia can reduce mortality rates significantly, according to a presentation by Atul Gawande, MD, a general and endocrine surgeon at the Brigham and Women's Hospital in Boston, at the Radiological Society of North America annual meeting. Such checklists should also be used before an incision and before a patient presents for surgery, with studies showing that checklists can reduce death rates by 45 percent.
From: Checklist Before Administering of Anesthesia Can Help Reduce Mortality Rates
4. Benchmark ASA physical class of patients. Dr. Wherry recommends benchmarking American Society of Anesthesiologists Physical Status of patients, which (for an ASC) will typically fall on a scale of 1 (normal, healthy patient) through 3 (patient with severe systemic disease). This will give you an idea of how healthy your patient population is and could alter the precautions you take with anesthesia or surgery.
From: 12 Anesthesia Processes to Track and Benchmark
5. Watch oxygen levels. Joe Elle Braden, RN, administrator of Marysville (Ohio) Surgical Center says that during procedures, her center's anesthesiologists are reminded to run the lowest appropriate concentration of oxygen during head and neck surgeries. Anesthesiologists can use a mix of oxygen and room air to lower the risk of OR fire outbreaks. "We try to keep the oxygen concentration at about 30 percent or less to prevent surgical fires," she says. "Normal healthy patients can certainly tolerate that, but it takes sound medical judgment to discern how far down you can go with patients."
From: 4 Tips for Improved Fire Safety in Operating Rooms
He says the cart should include multiple sizes of LMAs, as well as some type of fiberoptic instrument. An ASA document, titled "Practice Guidelines for Management of the Difficult Airway" and available on the ASA website, suggests the cart carry rigid laryngoscope blades of alternate design and size, tracheal tubes of assorted sizes and fat least one device suitable for emergency noninvasive airway ventilation, among others.
From: 4 Tips on Difficult Airway Management
2. Take special precautions with children and the elderly. According to Raafat S. Hannahllah, MD, professor of anesthesiology and pediatrics at The George Washington University Medical Center, special precautions must be taken to ensure anesthesia safety in ambulatory surgery on infants, very young children and elderly patients. In a SAMBA report, Dr. Hannahllah said the key to success of pediatric ambulatory surgery lies in careful selection, screening and preparation of prospective patients. Physicians should consider a child's physical status, the type of surgery, the type of facility and the ability of staff to deal with complications. He added that general inhaled anesthetics are most popular for younger patients.
Kathryn E. McGoldrick, MD, professor and chair of anesthesiology at New York Medical College, said anesthesiologists are increasingly asked to care for older patients in the ambulatory setting. Appropriate reductions in drug dosage must be made for geriatric patients, and anesthesiologists should pay careful attention to proper selection and titration of drugs, she said. She added that postoperative analgesia is vitally important because of the association of pain with the development of postoperative delirium in the elderly.
From: Screening, Drug Reduction Essential for Ambulatory Surgery of Very Old and Very Young Patients
3. Use a checklist for antiobiotic administration. Organizations which use checklists to ensure proper and timely administering of antibiotics, and confirm a patient's condition and operation, at various stages of the patient surgical process including before the administering of anesthesia can reduce mortality rates significantly, according to a presentation by Atul Gawande, MD, a general and endocrine surgeon at the Brigham and Women's Hospital in Boston, at the Radiological Society of North America annual meeting. Such checklists should also be used before an incision and before a patient presents for surgery, with studies showing that checklists can reduce death rates by 45 percent.
From: Checklist Before Administering of Anesthesia Can Help Reduce Mortality Rates
4. Benchmark ASA physical class of patients. Dr. Wherry recommends benchmarking American Society of Anesthesiologists Physical Status of patients, which (for an ASC) will typically fall on a scale of 1 (normal, healthy patient) through 3 (patient with severe systemic disease). This will give you an idea of how healthy your patient population is and could alter the precautions you take with anesthesia or surgery.
From: 12 Anesthesia Processes to Track and Benchmark
5. Watch oxygen levels. Joe Elle Braden, RN, administrator of Marysville (Ohio) Surgical Center says that during procedures, her center's anesthesiologists are reminded to run the lowest appropriate concentration of oxygen during head and neck surgeries. Anesthesiologists can use a mix of oxygen and room air to lower the risk of OR fire outbreaks. "We try to keep the oxygen concentration at about 30 percent or less to prevent surgical fires," she says. "Normal healthy patients can certainly tolerate that, but it takes sound medical judgment to discern how far down you can go with patients."
From: 4 Tips for Improved Fire Safety in Operating Rooms