2025 ISOBS OBA emergency manual: new drugs, devices, diversions, and dysfunction

Office-based anesthesia (OBA) and surgery continue to grow as hospitals shift procedures to the outpatient setting. The original 2017 Institute for Safety in Office-Based Surgery emergency manual provided guidance for the response of critical events in the office setting. Recent trends in medication use, procedural complexity, and patient comorbidities necessitate an update. This new emergency manual addresses the management of events such as aspiration or ketoacidosis that may be seen with increasing use of glucagon-like peptide-1 receptor agonists (GLP1-RAs) or sodium-glucose cotransporter 2 (SGLT2) inhibitors, workplace violence, malfunctioning of cardiac implantable electronic devices (CIEDs), fat embolism, postoperative airway problems, and postoperative cognitive dysfunction (POCD).

Recent literature emphasizes the growing complexity of procedures and patients in OBA. With the rising use of GLP1-RAs, providers must be prepared for the risk of aspiration from delayed gastric emptying. In addition, the prevalence of CIEDs requires emergency preparedness as procedures utilizing electrocauterization enter the office space. Furthermore, postoperative airway complications and POCD are concerning due to increasing patient BMI, risk of anaphylaxis from medications, and increased use of diabetic medications such as GLP1-RAs and SGLT2 inhibitors.

Recent literature on emergencies and medical society recommendations were used to guide the development of the 2025 OBA emergency manual. Further research and emergency reporting are required to reveal future trends and needs.