Anesthetic practices in ambulatory aesthetic surgery

Although ambulatory aesthetic surgery is commonly practiced and information concerning methods of anesthesia is readily available, little is known about the prevalence of various anesthetic practices and whether such practices differ according to the location of surgery. To obtain this information, we sent a carefully structured, 16-page, 69-item questionnaire to the members of the American Society for Aesthetic Plastic Surgery. Six hundred four (76.6 percent) of the 789 actively practicing members returned questionnaires, an exceptionally high response rate. Of interest are the following findings. More than 50 percent of the respondents operate in their offices half or more of the time. About one-half never perform aesthetic surgery in the hospital. Free-standing ambulatory surgical facilities are used less frequently. A wide range of laboratory studies are ordered routinely, regardless of the location of surgery or age of the patient. Local anesthesia with intravenous sedation is widely used in all settings. When employed for office surgery, neither a nurse anesthetist nor an anesthesiologist is present about one-third of the time. General anesthesia is used in half of the office surgical units and is administered by dedicated anesthesia personnel. About half of the time it is administered by an anesthesiologist and about half of the time by a nurse anesthetist. The intensity and methods of patient monitoring are similar in the office, in the hospital, and in a free-standing ambulatory surgical facility. Preoperative laboratory evaluation, monitoring, and the use of anesthetic agents are similar regardless of the surgical setting.