According to several online sources, about 65 percent (22 million) of all surgeries are performed on an outpatient basis, with many of them taking place at ambulatory surgical centers (ASCs). The two most common surgeries performed include endoscopies of the large and/or small intestine and extraction of lens. It is predicted that out of all surgeries performed in outpatient settings, only about 1 percent of them endure complications.

Both local and general anesthesia are used in most ambulatory surgical centers. Complications and risks accompanied with these sedation methods include:

  • Aspiration
  • Mental confusion
  • Stroke
  • Heart attack
  • Death
  • Embolism
  • Damage to teeth
  • Nerve injury
  • Many more

Due to the severe risks (even though they are rare), it’s imperative that all ASCs focus on ways to reduce complications. With reduced hindrances comes better patient care, and this should be the ultimate goal that every ambulatory surgery center strives to attain.

Anesthetic complexities: The common causes

  • Human error
  • Equipment failure/misuse
  • Adverse effects
  • Patient-related factors

Methods for deterring complications

Necessity of a highly-trained anesthesia provider
First and foremost, anesthesia should never be administered by someone who doesn’t have the proper credentials, licensure and experience. Becoming an anesthesiologist — not a anesthesiologist assistant — takes about 12 years of schooling and training.

It is imperative that all ASCs focus on ways to reduce anesthesia complications. With reduced hindrances comes better patient care, and this should be the ultimate goal that every ambulatory surgery center strives to attain.

Careful review of past health records (especially those pertaining to previous surgeries)
Secondly, prior health records and data of a patient should be carefully reviewed to identify any issues that may inadvertently result in complications. With the use of electronic medical records, it’s easier than ever before to receive patient records. Patients no longer have to travel from one physician to the next to collect their records because they can simply call and have the records electronically mailed to the ASC performing the surgery.

Familiarity with equipment
Since not all equipment is the same, when bringing a new anesthesiologist on board, it’s crucial that he or she become familiar with using the various devices, including the anesthetic machine itself, oxygen tanks, endotracheal tubes, and carbon dioxide absorber. Incorrect usage of the equipment will likely lead to surgical impediments.

Inspection of the different equipment pieces used should be conducted before each surgical procedure. Empty oxygen tanks, a broken vaporizer and other issues can be detrimental if complications were to arise.

Assessing the patient
Adverse effects of anesthesia can occur in any patient. Anesthesia providers should conduct a thorough evaluation that identifies if the patient suffers from any complication-influencing factor, with those factors including:

  • Daily alcohol use
  • Improper assessment of the patient
  • Past negative family/personal reactions to anesthesia
  • Sleep apnea
  • Heavy consumption of aspirin and NSAIDS
  • Smoking
  • Heart/lung/kidney conditions

Patient-related factors that increase the chance of anesthesia complications include:

  • General poor condition
  • Pediatric patients
  • Trauma patients (however most ASCs do not perform trauma related surgeries)
  • Geriatric patients
  • Systemic disease

Anesthesia complications associated with any of the above mentioned factors can most times be prevented. Once again, it’s imperative that a comprehensive patient exam be conducted, as well as to take a careful look at the patient’s past healthy history, to determine if any of the factors are present. If one or more factor is noted, then an anesthetic plan may need to be altered to complement the patient’s special needs.

Adequate time in recovery

The risk for complications concurred with anesthesia does not end when the administration of the anesthesia has ceased. Recovery is a vital time to monitor the patient’s heart rate and blood pressure. The length of time that a patient has to stay in recovery will vary from one to the next, and it will greatly be influenced by the procedure carried out and whether or not any complications were present during surgery.

With proper preparation, anesthesia complications can be kept to a minimum.

 

SOURCES
http://www.ruralareavet.org/PDF/Anesthesia-Responding_to_Complications.pdf
http://www.healthpages.org/surgical-care/anesthesia/#risks-of-general-anesthesia
http://www.cdc.gov/nchs/pressroom/09newsreleases/outpatientsurgeries.htm
http://en.wikipedia.org/wiki/Outpatient_surgery
http://www.webmd.com/a-to-z-guides/anesthesia-risks-what-patients-should-know

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abeo Management Corporation (abeo) serves as a leading source of revenue cycle management and practice management with a specialization in anesthesia. The company leverages its people, processes, and software to serve independent practices, surgery centers, hospitals and healthcare systems with a scope of services that include billing, coding, transcription, practice management, and business consulting.

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