APSF Panel Provides Guidance to Public, Patients: “Questions to Ask Before Accepting Office-Based Anesthesia”

Robert K. Stoelting, MD

President of APSF
For the Panel*

Patients may erroneously assume that surgery and anesthesia performed in the physician’s office will be “identical” to that in the traditional hospital operating room or ambulatory surgery facility. Such may not be the case and patients (“the public”) must be educated to ask the proper questions to both assure the “safety” of their individual experiences and to provide an incentive for establishment of a “single safety standard” regardless of the site where surgery and anesthesia are performed. In this regard, the following questions (based on my views and the suggestions of anesthesiologists and Certified Registered Nurse Anesthetists)* may be useful and informative for patients to ask prior to consenting to a surgical procedure that requires anesthesia in a physician’s office.

  1. Is your office accredited for performance of surgery and administration of anesthesia?
  2. How many of these operations have you performed and would you have this operation in an office such as yours if you were the patient
  3. Are you credentialed to perform this operation in a hospital or ambulatory surgery
  4. Who will administer my anesthesia and what are his/her qualifications?
  5. Is the individual administering my anesthesia credentialed to administer anesthesia in an accredited hospital or ambulatory surgery facility?
  6. Is the individual administering my anesthesia certified by his/her certifying organization?
  7. When will I meet the individual responsible for administering my anesthesia?
  8. What are the choices available to me for anesthesia?
  9. Will the individual administering my anesthesia be in constant attendance with me during my anesthetic?
  10. Will the anesthesia machine used for my anesthetic be modern and equivalent to the machine that would be used if I had this operation in a hospital or ambulatory surgery facility?
  11. Will the monitors used on me during my anesthetic be the same that would be used if I had this operation in a hospital or ambulatory surgery facility?
  12. you have necessary equipment and drugs to handle any possible emergency that might occur during or following my anesthetic?
  13. What hospital will I be admitted to should a complication occur during my anesthetic?
  14. Is there a separate area where I will be taken to awaken from my anesthetic?
  15. What are the qualifications of the individual who will monitor me in this recovery area?
  16. Will the monitors used during my recovery from anesthesia be the same that would be used if I was recovering after surgery in a hospital or ambulatory surgery facility?
  17. Is the recovery area in your office equipped in a similar manner to the recovery area in a hospital or ambulatory surgery facility?
  18. Who is responsible for determining if I am ready to be discharged home?
  19. Who is ACLS certified in your office?
  20. How is the operating room cleaned between cases?
  21. How are the surgical instruments sterilized?
  22. Is appropriate surgical attire worn by those in attendance during my surgery?

*[The following individuals, by virtue of their membership in the APSF Board of Directors and/or expertise in OBA, participated in the development of these questions: John Aker, CRNA, Raafat S. Hannallah, MD, David C. Mackey, MD, Vinod Malhotra, MD, David B. Mayer, MD, Beverly K. Nichols, CRNA, Beverly K. Philip, MD, Ann M. Showan, MD, Richard E. Tirrell, MD, Rebecca S. Twersky, MD, Bette M. Wildgust, CRNA, John A. Youngberg, MD]