Obstructive sleep apnea (OSA) is the most common form of sleep-related breathing disorder encountered in the perioperative setting. It is defined by recurrent upper airway collapse, potentially leading to decreased oxygen levels during sleep and an increased risk of long-term cardiovascular illness. While OSA is more prevalent in surgical candidates than in the general population, between 60-90% of patients remain undiagnosed. OSA has been associated with a high risk of perioperative complications and a resultant increase in hospital cost and resource utilization.
As the director of a preoperative clinic, one of the recurring challenges I face is the appropriate scheduling of ambulatory versus inpatient procedures. It is remarkable how many patients with significant medical issues may safely undergo ambulatory procedures if carefully selected. Innovative surgical techniques, shorter-acting anesthetic agents, and changes in reimbursement models have increased interest in ambulatory surgery. At the same time, however, an aging population with an increasing disease burden significantly complicates the decision as to who is an appropriate candidate for an outpatient procedure.
To access the survey response, click on the image above.
Society for Ambulatory Anesthesia Response to the Leapfrog Group Survey 12/15/2019
The Society for Ambulatory Anesthesia (SAMBA) is the premier society for ambulatory physician anesthesiologists, with membership available to all physicians and professionals with interest in ambulatory surgical care.
We disagree with some of the negative, unsupported comments made by the Leapfrog group representatives in the preliminary findings of their ASC survey. In response we wish to highlight our organization’s efforts to advance patient safety.
Click here to review Leapfrog’s preliminary findings from their ASC survey.
The need for sedation and anesthesia care for pedi-atric patients in non-O.R. locations has increased significantly during the past decade. It is not uncommon for such children to represent anywhere from 10 to 24 percent of the daily case load, as noted by Campbell and associates.1 Without psychological and other non-pharmacological interventions, pediatric patients are unlikely to cooperate and lay still even for non-painful diagnostic MRI procedures unless the procedures are brief, as during a CT examination.
Manual of Practice Management for Ambulatory Surgery Centers
This key resource provides insight and guidance to managing ambulatory surgery centers (ACSs) from a broad spectrum of expertise. Intended for a wide audience of healthcare professionals, this book covers topics such as regulatory issues, outpatient pediatric anesthesia, inventory management, personnel training, the culture of safety, and sedation standards.
The format found in each chapter is designed intentionally to function as an educational manual. Many chapters are supplemented by high quality figures and tables to aid in visual learning.
This text brings together authors from diverse professions including lawyers, administrators, surgeons, anesthesiologists and architects. Manual of Practice Management for Ambulatory Surgery Centers: An Evidence-Based Guide is a concise and evidence-based guide to successfully operating the modern health care facilities that have transformed the outpatient experience for millions of people.
Provides a comprehensive guide for medical directors, administrators, anesthesiologists, surgeons, and perioperative leaders in the management of ASCs
Concise and evidence-based guide to common pitfalls and situations that arise during the running of an ASC or office-based practice
Resource for ASC and office –based practice leadership in addressing issues that arise during the management of these practices
Topics covered include ASC construction, anesthesia billing, sedation standards, protocols, and guidelines, the culture of safety, and outpatient pediatric anesthesia
The Manual of Practice Management for Ambulatory Surgery Centers is a SAMBA publication in collaboration with Springer Nature publishing.
Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting
This consensus statement presents a comprehensive and evidence-based set of guidelines for the care of postoperative nausea and vomiting (PONV) in both adult and pediatric populations. The guidelines are established by an international panel of experts under the auspices of the American Society of Enhanced Recovery and Society for Ambulatory Anesthesia based on a comprehensive search and review of literature up to September 2019.
Dr. Abdelmalak and Dr. Belani represented SAMBA at the ASA subspecialty kiosk during the ASA Annual Meeting October 19-23.
SAMBA and the Indian College of Anesthesiologists have a common interest to improve patient care and safety within the ambulatory anesthesia medical field. We will be partnering and collaborating through marketing, promotion and communications.
For more than forty years, ASCs have provided high-quality, cost-efficient surgical care for millions of Americans. In that time, ASCs have transformed the outpatient experience by offering a convenient and personalized alternative to the hospital outpatient surgical setting.
For the last decade, ASCs have promoted awareness of these contributions by opening their doors to their communities and hosting National ASC Month events. By hosting an event in your community, you can educate key policy and decision makers about the benefits of ASCs and encourage public awareness of your ASC. Effective events include inviting your elected officials to tour your surgery center and hosting an open house to provide more information to patients.
Letter from the President
On behalf of all SAMBA members,
I want to thank Basem Abdelmalak, MD, FASA, SAMBA President 2019-2020, for the excellent service he has provided our society for the past year. Dr. Abdelmalak worked tirelessly executing SAMBA’s mission and vision. During his tenure, we signed cooperation agreements with multiple Anesthesiology organizations from around the world, including, the American Society of Anesthesiologists, European Society of Anesthesiologists, the Croatian Society of Anesthesiology and Intensive Care Medicine, the Brazilian Society of Anesthesiologists, and the Sao Paulo State Society of Anesthesiologists.
A few weeks ago, I was mapping out the projects for the year that I will serve as SAMBA’s President. My main goal is to enhance the business acumen of our members. Based on the interesting interactions in Q/A sessions at the annual meetings, and your feedback, we plan to have a Medical Directors track in future Annual Meetings. We are considering a SAMBA Medical Director education and certification program, open to SAMBA active and associate members.
As Anesthesiology Medical Directors, on the one hand, we provide medical care to our patients. SAMBA provides statements and guidelines to improve medical management:
Preoperative risk assessment calls, information gathering, and patient selection
Perioperative pain management, multimodal analgesia, and regional anesthesia
Consultations and intraoperative care
Post-operative care, discharge
Complication management and transfers
On the other hand, Medical Directors are also the Chief Medical Officers of the facility and have different responsibilities:
Design and implementation with the administrative team the facility’s competitive advantage
Leadership and team building
Patient experience and satisfaction
Surgeon selection and surgeon satisfaction
Scheduling and blocked time management
Patient safety and quality management
Quality measures, benchmarks, SQI
Help manage staff, scheduling conflicts, and medication management
Credentialing and recredentialing
Policies, procedures, medical executive committee, governing board.
Prevention of human-to-human and equipment-to-human transmission.
Implementation of checklists to reopen the facilities to ensure an adequate supply of medications and equipment necessary to proceed with procedures safely.
Maintain excellent communication with patients and staff about measures being taken.
Let’s not forget about ourselves, and our families – we must stay healthy.
It is our wish that all Ambulatory Surgery Centers take advantage of the SAMBA Ambulatory Surgery Center membership. For a discounted price, Anesthesiologists and non-Anesthesiologists that work at member facilities become SAMBA members and enjoy all the educational opportunities that SAMBA provides. SAMBA will continue to work on behalf of our members, developing content to keep them updated.
We plan to deploy a SAMBA app from which members can access the content on our website. We aim to create an index and pertinent content to serve as reference for ambulatory anesthesiologists. SAMBA recently published a Manual of Practice Management for Ambulatory Surgery Centers, which members can purchase with a 25% discount.
We are working on a combined virtual regional anesthesia meeting/workshop with the European Society of Regional Anesthesia (ESRA). We are planning a virtual Medical Director’s meeting. Many members have visited the membership forum, where you can find additional content related to our webinars, questions and answers by our Board Members, including our Past-Presidents.
Thank you for the opportunity to serve and help enhance our specialty.
Leopoldo V. Rodriguez, MD, MBA, FAAP, FASA
President, Society for Ambulatory Anesthesia 2020 – 2021
Basem B. Abdelmalak, MD, FASA is a professor of anesthesiology at Cleveland Clinic Lerner College of Medicine. He has served in the Department of General Anesthesiology as a Staff Anesthesiologist since 2001. Currently he leads Anesthesia Services for Bronchoscopic Surgery as a NORA service and is the Director of the Center for Sedation implementing the anesthesiology oversight for procedural sedation. He frequently performs the Therapeutic Whole Lung Lavage procedure to treat pulmonary alveolar proteinosis patients.
Dr. Abdelmalak is board-certified in Anesthesiology and fellowship trained in Critical Care medicine. His many clinical interests include anesthesia for ENT and bronchoscopic surgery, difficult airway management.
He served the Ohio Society of Anesthesiologists as its president in 2015 and currently serves the American Society of Anesthesiologists (ASA) as the Vice-chair of the educational track subcommittee on Ambulatory Anesthesia, the Society for Head and Neck Anesthesia (SHANA), as a founding member, and its president
At the Society for Ambulatory Anesthesia (SAMBA) he served in many roles and capacities; as a member of the committees on the Annual meeting, NORA, and Finance, and chair of the Development committee for the past 7 years leading SAMBA’s relationships with corporate sponsors, and pharmaceutical and industrial supporters. He then served on the Board of Directors, as a director, Vice President, President –elect, and now as its President.
He is also a part of the Anesthesiology Outcomes Research Department. His research interest is focused on the study of perioperative glycemic management, and he has been the primary investigator of many research projects investigating this and other topics.
He has received numerous honors and awards, including being named one of America’s Top Anesthesiologists according to the Consumers’ Research Council of America and Safety Champion by the Cleveland Clinic Quality Institute. A frequently invited lecturer at national and international conferences, Dr. Abdelmalak authored many scientific articles and book chapters in his field, and recently co-edited two textbooks titled Anesthesia for Otolaryngologic Surgery and Clinical Airway Management; An Illustrated Case Based Approach by Cambridge University Press. He continues to be heavily involved with the education and training of medical students and residents and recently received the Scholarship in Teaching Award from Case Western Reserve University.