Office-Based Anesthesia

SAMBA’s Office-Based Anesthesia Committee explores the particular issues related to administering anesthesia in a physician’s office outside of a hospital or surgery center. 

Crisis Management Training in Office-Based Anesthesia

Only available to SAMBA members – login to the member portal here to read more.

Preview curriculum by clicking image above.

OFFICE-BASED ANESTHESIA REVISED 2020 CURRICULUM

This updated curriculum provides the resident with a comprehensive experience in the anesthetic management of ambulatory surgical patients in an office based environment. Demonstrate a general knowledge of the office-based anesthesia literature for understanding the important changes in office-based anesthesia over the last 20 years(…)

To access full revised curriculum, click here.

State Legislative and Regulatory Issues

Visit the ASA website to learn more.

State Legislative and Regulatory Issues

Visit the ASA website to learn more.

Why Office-Based Anesthesia?

By. Grace Lee Dorsch, MD

For years I had been attending SAMBA conferences. I had heard about office based practices and listened to lectures about it. Frankly, it scared me. I had always worked in a hospital or out patient center. (Traditional anesthesia…operating rooms, anesthesia aides/techs, PACU nurses). However, the practice I was working with as a part-time employee, was changing. They were merging and were looking to hire only full time. I seriously started looking into starting my own office based practice. I wanted to work in an environment that put patients first and not all about the business. 

Advantages: 

  • make own schedule 
  • no call
  • no weekends 
  • flexible hours 
  • control everything… type cases, type practice, adults, pediatric, cash or fee for service 

Disadvantages:

  • no back-up
  • no income unless you are working, unless multiple providers
  • no lunch breaks
  • no bathroom breaks

How to get started with an office based practice.

Think about what kind of cases you want…Talk to practitioners you might be interested in working with. Look into different business models.

I choose a “concierge anesthesia model.”  I am fee-for-service only. I provide personal services for my offices “chair to car.” I pre-op, post-op, and follow-up. I have very low overhead. I take all equipment/supplies with me. Offices only supply oxygen, AED, and controlled substances.

How to sell it? Ask the practitioners: do you want to increase your productivity and be more time efficient in your office? Dentist or surgeon can being seeing patients up until time you are ready, and they can be back seeing patients while you are recovering and discharging. Their productivity increases; there is much less time out of office compared to doing cases in OR where many have to block off large part of their day.

Many dental practices have high anxiety patients or are doing more invasive or lengthy procedures where patients might prefer to be asleep. The pediatric dental population and special needs cases in the dental office often require anesthesia. This is an ideal scenario for your office based practice to flourish.

Ambulatory Anesthesia: The Innovating Edge of Perioperative Medicine?

Fleisher LA.

Anesthesiol Clin. 2019 Jun;37(2):xiii-xiv.

Preoperative Evaluation for Ambulatory Anesthesia: What, When, and How?

Okocha O, Gerlach RM, Sweitzer B.

Anesthesiol Clin. 2019 Jun;37(2):195-213

Suitability of outpatient or ambulatory extended recovery cancer surgeries for obese patients.

Vertosick EA, Assel M, Tokita HK, Zafirova Z, Vickers AJ, Simon BA, Twersky R.

J Clin Anesth. 2019 Dec;58:111-116.

Efficiency and scheduling in the nonoperating room anesthesia suite: implications from patient satisfaction to increased revenue operating room: a common (Dollars and Sense) approach.

Navidi B, Kiai K.

Curr Opin Anaesthesiol. 2019 Aug;32(4):498-503.

Pediatric Ambulatory Anesthesia Challenges.

Butz SF.

Anesthesiol Clin. 2019 Jun;37(2):289-300.

Regional Anesthesia for Ambulatory Anesthesiologists.

Ardon AE, Prasad A, McClain RL, Melton MS, Nielsen KC, Greengrass R.

Anesthesiol Clin. 2019 Jun;37(2):265-287.

Factors Determining the Choice of Spinal Versus General Anesthesia in Patients Undergoing Ambulatory Surgery: Results of a Multicenter Observational Study.

Capdevila X, Aveline C, Delaunay L, Bouaziz H, Zetlaoui P, Choquet O, Jouffroy L, Herman-Demars H, Bonnet F.

Adv Ther. 2019 Dec 11.

Preoperative Assessment of Obstructive Sleep Apnea in the Ambulatory Anesthesia Patient: A Survey of Oral and Maxillofacial Surgery Providers.

Goldberg JM, Johnson MP, Safian MJ.

J Oral Maxillofac Surg. 2019 Jun;77(6):1135-1142.

Outcomes in Ambulatory Anesthesia: Measuring What Matters.

Rodriguez LV, Bloomstone JA, Maccioli GA.

Anesthesiol Clin. 2019 Jun;37(2):361-372.

Quality Improvement in Ambulatory Anesthesia: Making Changes that Work for You.

Jankowski CJ, Walsh MT.

Anesthesiol Clin. 2019 Jun;37(2):349-360.

Total intravenous anaesthesia in ambulatory care.

McIlroy EI, Leslie K.

Curr Opin Anaesthesiol. 2019 Dec;32(6):703-707.

Value-Based Payment in Ambulatory Anesthesia: MACRA, MIPS, and More.

Merrill DG.

Anesthesiol Clin. 2019 Jun;37(2):373-388.

Evidence Basis for Regional Anesthesia in Ambulatory Arthroscopic Knee Surgery and Anterior Cruciate Ligament Reconstruction: Part II: Adductor Canal Nerve Block-A Systematic Review and Meta-analysis.

Sehmbi H, Brull R, Shah UJ, El-Boghdadly K, Nguyen D, Joshi GP, Abdallah FW.

Anesth Analg. 2019 Feb;128(2):223-238.

Pain Management for Ambulatory Arthroscopic Anterior Cruciate Ligament Reconstruction: Evidence-Based Recommendations From the Society for Ambulatory Anesthesia.

Abdallah FW, Brull R, Joshi GP; Society for Ambulatory Anesthesia (SAMBA).

Anesth Analg. 2019 Apr;128(4):631-640.

Anesthesia for thoracic ambulatory surgery.

Raft J, Richebé P.

Curr Opin Anaesthesiol. 2019 Dec;32(6):735-742.

Impact of Chloroprocaine on the Eligibility for Hospital Discharge in Patients Requiring Ambulatory Surgery Under Spinal Anesthesia: An Observational Multicenter Prospective Study.

Capdevila X, Aveline C, Delaunay L, Bouaziz H, Zetlaoui P, Choquet O, Jouffroy L, Herman-Demars H, Bonnet F.

Adv Ther. 2019 Dec 11.

Pediatric ambulatory anesthesia: an update.

Lerman J.

Curr Opin Anaesthesiol. 2019 Dec;32(6):708-713.

Evidence Basis for Regional Anesthesia in Ambulatory Anterior Cruciate Ligament Reconstruction: Part I-Femoral Nerve Block.

Vorobeichik L, Brull R, Joshi GP, Abdallah FW.

Anesth Analg. 2019 Jan;128(1):58-65.

Malignant Hyperthermia-Susceptible Adult Patient and Ambulatory Surgery Center: Society for AmbulatoryAnesthesia and Ambulatory Surgical Care Committee of the American Society of Anesthesiologists Position Statement.

Urman RD, Rajan N, Belani K, Gayer S, Joshi GP.

Anesth Analg. 2019 Aug;129(2):347-349.

Evidence Basis for Regional Anesthesia in Ambulatory Anterior Cruciate Ligament Reconstruction: Part III: Local Instillation Analgesia-A Systematic Review and Meta-analysis.

Yung EM, Brull R, Albrecht E, Joshi GP, Abdallah FW.

Anesth Analg. 2019 Mar;128(3):426-437.

Improving intraoperative handoffs for ambulatory anesthesia: challenges and solutions for the anesthesiologist.

Dexter F, Osman BM, Epstein RH.

Local Reg Anesth. 2019 May 24;12:37-46.

Procedural sedation in ambulatory anaesthesia: what’s new?

Raeder J.

Curr Opin Anaesthesiol. 2019 Dec;32(6):743-748.

The development of an opioid sparing anesthesia protocol for pediatric ambulatory tonsillectomy and adenotonsillectomy surgery-A quality improvement project.

Franz AM, Dahl JP, Huang H, Verma ST, Martin LD, Martin LD, Low DK.

Paediatr Anaesth. 2019 Jul;29(7):682-689.

Chloroprocaine versus prilocaine for spinal anesthesia in ambulatory knee arthroscopy: a double-blind randomized trial.

Wesselink E, Hurk GJD, Vegt RV, Slagt C, Aa JV, Franssen E, Ven PV, Swart N, Boer C, Leeuw M.

Reg Anesth Pain Med. 2019 Aug 21.

Obesity and Obstructive Sleep Apnea in the Ambulatory Patient.

Grewal G, Joshi GP.

Anesthesiol Clin. 2019 Jun;37(2):215-224. 

Incidence of postoperative delirium in elderly ambulatory patients: A prospective evaluation using the FAM-CAM instrument.

Aya AGM, Pouchain PH, Thomas H, Ripart J, Cuvillon P.

J Clin Anesth. 2019 Mar;53:35-38.

Anesthesia for Ambulatory and Office-Based Ear, Nose, and Throat Surgery.

Rodriguez LV.

Otolaryngol Clin North Am. 2019 Dec;52(6):1157-1167.

Guidelines for day-case surgery 2019: Guidelines from the Association of Anaesthetists and the British Association of Day Surgery.

Bailey CR, Ahuja M, Bartholomew K, Bew S, Forbes L, Lipp A, Montgomery J, Russon K, Potparic O, Stocker M.

Anaesthesia. 2019 Jun;74(6):778-792.

Recovery and discharge criteria after ambulatory anesthesia: can we improve them?

Jakobsson JG.

Curr Opin Anaesthesiol. 2019 Dec;32(6):698-702.

An exploratory study of the relationship between postoperative nausea and vomiting and postdischarge nausea and vomiting in children undergoing ambulatory surgery.

Chandrakantan A, Reinsel RA, Jasiewicz R, Jacob ZC, Seidman PA.

Paediatr Anaesth. 2019 Apr;29(4):353-360.

Older Adult With Cognitive Impairment Undergoing Ambulatory Surgery: New Epidemiological Evidence With Implications for Anesthesia Practice.

Urman RD, Joshi GP.

Anesth Analg. 2019 Jul;129(1):10-12.

Anesthesia for Same-Day Total Joint Replacement.

Amundson AW, Panchamia JK, Jacob AK.

Anesthesiol Clin. 2019 Jun;37(2):251-264.

Outcomes and Safety Among Patients With Obstructive Sleep Apnea Undergoing Cancer Surgery Procedures in a Freestanding Ambulatory Surgical Facility.

Szeto B, Vertosick EA, Ruiz K, Tokita H, Vickers A, Assel M, Simon BA, Twersky RS.

Anesth Analg. 2019 Aug;129(2):360-368.

A preoperative predictive model for prolonged post-anaesthesia care unit stay after outpatient surgeries.

Elsharydah A, Walters DR, Somasundaram A, Bryson TD, Minhajuddin A, Gabriel RA, Grewal GK.

J Perioper Pract. 2019 May 28.

Analgesic efficacy of ultrasound-guided interscalene block vs. supraclavicular block for ambulatory arthroscopic rotator cuff repair: A randomised noninferiority study.

Cabaton J, Nové-Josserand L, Mercadal L, Vaudelin T.

Eur J Anaesthesiol. 2019 Oct;36(10):778-786.

Outcomes of Ambulatory Upper Extremity Surgery Patients Discharged Home with Perineural Catheters from a Veterans Health Administration Medical Center.

King R, Mariano ER, Yajnik M, Kou A, Kim TE, Hunter OO, Howard SK, Mudumbai SC.

Pain Med. 2019 Mar 11.

Respiratory Depression Following Ambulatory Urogynecologic Procedures: A Retrospective Analysis.

Gali B, Gritzner SR, Henderson AJ, Warner ME, Sibanda SL, Sprung J, Weingarten TN.

Mayo Clin Proc Innov Qual Outcomes. 2019 May 27;3(2):169-175.

Association of peripheral nerve blocks with postoperative outcomes in ambulatory shoulder surgery patients: a single-centre matched-cohort study.

Hamilton GM, Ramlogan R, Lui A, McCartney CJL, Abdallah F, McIsaac DI.

Can J Anaesth. 2019 Jan;66(1):63-74.

Can simple perioperative measures improve quality of recovery following ambulatory laparoscopic surgery in females? An open prospective randomised cohort study, comparing nutritional preoperative drink and chewing gum during recovery to standard care.

Öbrink E, Lerström J, Hillström C, Oddby E, Jakobsson JG.

Ann Med Surg (Lond). 2019 Jun 8;44:20-25.

Enhanced Recovery Programs in Outpatient Surgery.

Afonso AM, Tokita HK, McCormick PJ, Twersky RS.

Anesthesiol Clin. 2019 Jun;37(2):225-238.

The Standardization of Outpatient Procedure (STOP) Narcotics: A Prospective Health Systems Intervention to Reduce Opioid Use in Ambulatory Breast Surgery.

Hartford LB, Van Koughnett JAM, Murphy PB, Knowles SA, Wigen RB, Allen LJ, Clarke CFM, Brackstone M, Gray DK, Maciver AH.

Ann Surg Oncol. 2019 Oct;26(10):3295-3304.

Analgesic strategies for day-case knee surgery.

Wojcikiewicz T, El-Boghdadly K.

Anaesthesia. 2019 Apr;74(4):529-533.

Partnership with Interventional Pulmonologist: An Anesthesiologist’s Perspective.

Suhre WM, Lang JD Jr, Madtes DK, Abdelmalak BB.

Otolaryngol Clin North Am. 2019 Dec;52(6):1049-1063.

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Basem B. Abdelmalak, MD, FASA

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.

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