SAMBA Clinical Practice Guidelines and Statements
March 2024
This consensus statement is a comprehensive update of the 2010 Society for Ambulatory Anesthesia (SAMBA) Consensus Statement on perioperative blood glucose management in patients with diabetes mellitus (DM) undergoing ambulatory surgery.
March 2024
In response to requests from our members without pediatric fellowship training and/or who care for pediatric patients infrequently, the Pediatric Committee of the Society for Ambulatory Anesthesia (SAMBA) developed a position statement with recommendations for the safe perioperative care of pediatric patients undergoing tonsillectomy with and without adenoidectomy in freestanding ambulatory surgical facilities.
SAMBA supports the utilization of the ASA difficult airway algorithm in airway management when the situation arises in ambulatory sites. Updates to the algorithm in 2022 include recommendations from international anesthesiologists, updated equipment for airway management, suggestions for extubating difficult airway patients, and new infographics and algorithms.
December 2021
We present SAMBA’s position statement for preoperative care for cataract surgery. Most cataracts can be treated using topical or regional anesthesia with minimum or no sedation. There is minimal risk of adverse outcomes. There is general consensus that cataract surgery is extremely low risk, and the benefits of sight restoration and preservation are enormous.
September 27, 2021
SAMBA supports the placement of intravenous catheters, venipunctures, and blood pressure measurements in an upper extremity ipsilateral to breast cancer surgery with and without axillary lymph node dissection.
April 2021
SAMBA, SASM and SOCCA have collaborated to investigate and provide guidelines for post-operative management in patients with OSA. Pre-operative screening and intraoperative management guidelines exist, and this project will complement and complete evidence-based perioperative recommendations for patients with OSA. Stay tuned for the publication…
2021
More institutions are utilizing pectoralis blocks for breast surgery. This could lead to a reduction in PACU opioid consumption and decrease postoperative pain scores when compared to systemic analgesics. PECs blocks seem to be equal in comparison to a single-shot paravertebral injection regarding postoperative opioid requirements and time to rescue analgesia. Although further investigation is necessary, these blocks could be an extremely useful tool in the ambulatory setting.
August 2020
A systematic review of the literature was performed through 2019 to update the guidelines for managing PONV. One major update is the recommendation to administer multimodal prophylactic medications in patients with just 1 or 2 PONV risk factors. Combination therapy should be used for prophylaxis, and medication from a different class than was given prophylactically should be administered in need of rescue.
August 2019
This statement represents a joint effort of the Society for Ambulatory Anesthesia (SAMBA) and the Ambulatory Surgical Care Committee of the American Society of Anesthesiologists (ASA) concerning the safe anesthetic care of adult malignant hyperthermia (MH)-susceptible patients in a free-standing ambulatory surgery center (ASC).
April 2019
Anterior cruciate ligament reconstruction arthroscopic surgery patients often have moderate pain postoperatively. Multiple regional analgesia techniques have been used to decrease pain including femoral nerve or adductor canal blocks or local instillation by surgeons, and there is evidence to support each. Analyzing systematic reviews and endorsed by SAMBA, this paper found that local instillation was the best technique overall when combined with multimodal analgesia.
May 2017
This statement argues that, in the absence of succinylcholine, the morbidity and mortality from laryngospasm can be significant, indeed, higher than the unlikely scenario of succinylcholine- triggered malignant hyperthermia. The Society for Ambulatory Anesthesia (SAMBA) position statement for the use of succinylcholine for emergency airway management is presented.
November 2012
Patients with OSA can pose a challenge in the ambulatory setting with their increased risk of perioperative complications. SAMBA conducted a systematic review to develop practice guidelines as a tool for ambulatory centers. Patients with known and treated OSA, as well as those with presumed OSA can be considered for ambulatory surgery if they are medically optimized and able to use CPAP in PACU. Multimodal pain management is recommended to decrease perioperative opioid use and subsequent potential respiratory complications.
December 2010
A systematic review of the literature was performed to establish a consensus on glucose management in the ambulatory setting. It was found that evidence was lacking for strong perioperative glucose control recommendations. Based on general principles, SAMBA recommends a target glucose <180mg/dL in well-controlled diabetics and to maintain glucose around baseline in poorly controlled diabetics. The preferred route and medication are fast-acting subcutaneous insulin administration for its favorable pharmacokinetics, cost-effectiveness, and duration of action.
COVID Statements
February 23, 2021
The Society for Ambulatory Anesthesia (SAMBA) is concerned about the resurgence of COVID-19 cases throughout the country. Beginning in late fall 2020 viral spread and rates of infection dramatically increased. However, just very recently the numbers have started to mitigate, though rates of infection are almost twice the peaks that we saw in summer 2020. In addition, testing capabilities have escalated, and vaccination is being offered to healthcare workers and senior citizens. Read the full statement below.
May 1, 2020
Guidance on pre-operative COVID-19 testing and it’s application specifically to NORA and OBA, inclusive of procedures as well as surgeries, as of the date of issuance.
April 20, 2020
A statement on resuming ambulatory anesthesia care, as of the date of issuance, supported by our affiliate societies – the American Society of Anesthesiologists (ASA) and Ambulatory Surgery Center Association (ASCA).
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