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LETTER TO THE EDITOR

Ambulatory Anesthesia: Whither Thou Goest

President, Society for Ambulatory Anesthesia (SAMBA), Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, maurerw{at}ccf.org

To the Editor:

I was somewhat dismayed when scrutinizing the pictorial representation of the difficulties with scheduling cases on the cover of the December 2006 issue of Anesthesia & Analgesia, accompanying the articles on operating room management (1–3). Certainly, the symbolism of attempting to direct the path of a pachyderm through the pathetically small portal of operating hours does remind us all of the problems we face every day. However, the apportioning of parts among the anesthesia subspecialties seems rather incongruous. Given the economic incentives in ambulatory anesthesia reflecting a generally superior payor mix, one would anticipate that our subspecialty might more appropriately be reflected in the elephant’s trunk. Orthopedics is represented in the concentration of the predominantly bony tissue of the back. Neuroanesthesia occupies the head, and anesthesia for general surgery occupies the abdomen or underbelly, the location where many general surgeons practice. Cardiac seems to be sketched out vaguely near the heart of the elephant.

But having ambulatory anesthesia represented at the "tail" is unfortunately in keeping with the way many anesthesiologists, especially those not working in ambulatory surgical units, view this most important specialty. Nearly 80% of cases nationwide are now outpatient cases (4). Office-based anesthesia is presently the most rapidly expanding area of many practices, but has yet to be adequately taught in most residency programs (5). Thus it would seem that ambulatory surgery ought to occupy at least two-thirds of the animal with only small sections for the other subspecialties. Perhaps the intent was to represent the degree of scheduling problems caused by the more demanding surgical subspecialties other than ambulatory (neurosurgery, orthopedics, cardiothoracic, and general surgery). On the other hand, perhaps the goal was to indicate that most ambulatory surgery cases are "tacked on" at the end of other subspecialty cases as "to follow" cases in a busy surgical schedule.

Perhaps we in ambulatory anesthesia are overly sensitive to the admonition that "really anybody can do those outpatient cases." In actual fact, these cases can be some of the most challenging for the anesthesiologist given the increasing comorbidities and complexities of the surgical procedures, the demands for operating room efficiency and the expectations for patient satisfaction in the outpatient surgery venue. We do sincerely hope that the editors of Anesthesia & Analgesia will not continue to relegate the specialty of ambulatory anesthesia to that less desirable portion of the anatomy of the elephant. We’re the first through the gate, not the last.

REFERENCES

1. Shafer SL. Case scheduling for dummies. Anesth Analg 2006;103:1351–2.[Free Full Text]
2. McIntosh C, Dexter F, Epstein RH. The impact of service-specific staffing, case scheduling, turnovers, and first-case starts on anesthesia group and operating room productivity: a tutorial using data from an Australian hospital. Anesth Analg 2006;103: 1499–516.[Abstract/Free Full Text]
3. Dexter F, Epstein RH. Holiday and weekend operating room on-call staffing requirements. Anesth Analg 2006;103:1494–8.[Abstract/Free Full Text]
4. Projections of surgical procedures. Chicago: SMG Marketing Group, Inc, 1999.
5. Hausman LM, Levine AI, Rosenblatt MA. A survey evaluating the training of anesthesiology residents in office-based anesthesia. J Clin Anesth 2006;18:499–503.[Web of Science][Medline]

This article has been cited by other articles:

				S. L. Shafer Ambulatory Anesthesia: Whither Thou Goest Anesth. Analg., May 1, 2007; 104(5): 1299 - 1300. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Maurer, W. G. Search for Related Content PubMed PubMed Citation Articles by Maurer, W. G.