Physician-administered office anesthesia

Surgeons who administer office anesthesia accept a serious responsibility for the well-being of their patients. Each must be thoroughly familiar with the agents they employ and prepared to deal with any complications or untoward events that might arise out of their use. Patients who are healthy or have well-controlled mild systemic disease are generally suitable for office procedures. Overly apprehensive patients, those with a history of anesthetic difficulties, or any patient with significant medical problems should be provided an anesthesiologist or competent Certified Registered Nurse Anesthetist (CRNA). It is irresponsible and dangerous to administer anesthesia in a substandard facility or with an inadequate or inexperienced staff. All staff members should be BCLS (Basic Cardiac Life Support) qualified, and key individuals should be encouraged to obtain ACLS (Advanced Cardiac Life Support) certification. Proper pharmacologic preparation of the patient will allay anxiety, increase comfort, and reduce the overall quantity of anesthetic needed. Particularly useful agents include benzodiazepines (Valium and Versed) and diphenhydramine (Benadryl). Medication is not, however, a substitute for human contact, genuine concern, or timely reassurance. All patients receiving anything more than a small quantity of local anesthetic should be monitored by transcutaneous pulse oximetry, noninvasive sphygmomanometry, and real-time electrocardiography. Each provides important information on the patient's physiologic condition. Of these three monitors, the most important information is provided by the pulse oximeter. It is capable of detecting a problem before serious physiologic compromise has occurred and should be considered an indispensible part of each patient's care. A brief period of deep sedation for the administration of local anesthetic can safely be achieved using carefully titrated quantities of the short-acting barbiturate methohexital (Brevital). Gauging the proper end point of methohexital administration is accomplished through skilled observation of the patient. As the proper threshold is reached, a characteristic slackening of the jaw occurs usually in conjunction with a distinctive relaxation of the face. In the majority of cases, no change in the SaO2 will occur.(ABSTRACT TRUNCATED AT 400 WORDS)