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

Area of Science:

• Anesthesiology
• Outpatient Surgery
• Emergency Medicine

Background:

• Office-based anesthesia (OBA) and surgery are expanding as procedures move to outpatient settings.
• The original 2017 emergency manual requires updating due to evolving medical trends.
• Increased procedural complexity and patient comorbidities necessitate revised emergency protocols.

Purpose of the Study:

• To update the emergency manual for office-based anesthesia (OBA) to reflect current trends.
• To provide guidance for managing critical events in the office setting.
• To address new challenges including medication side effects, workplace violence, and device malfunctions.

Main Methods:

• Review of recent literature on OBA emergencies.
• Incorporation of medical society recommendations.
• Development of the 2025 OBA emergency manual.

Main Results:

• Growing complexity of procedures and patients in OBA is highlighted.
• Increased use of GLP1-RAs poses risks like aspiration due to delayed gastric emptying.
• Prevalence of cardiac implantable electronic devices (CIEDs) necessitates emergency preparedness for procedures using electrocauterization.

Conclusions:

• The 2025 OBA emergency manual incorporates recent literature and recommendations.
• Emerging concerns include postoperative airway complications and cognitive dysfunction (POCD).
• Further research and emergency reporting are crucial for identifying future trends and needs.