Anestesia Fuera De Quirófano

Anesthesia Outside the Operating Room

Foreword

Lee A. Fleisher, MD, FACC Consulting Editor

Increasingly, we are being asked to provide anesthesia or heavy sedation for patients undergoing procedures outside of the operating room. This represents a clinical, staffing, and financial challenge to most anesthesiology departments. While provision of anesthesia services within an operatingroom environment has been associated with increasing safety over the past several decades, settings outside of the operating room may present unique challenges. For these reasons, it is important the Anesthesiology Clinics address this important topic. In this issue, three major areas of care are addressed: financial implications, optimal care paradigms for specific patients, and locations andpriorities with respect to all out-of-operating-room settings. In choosing editors for this issue, it became important to identify forward thinkers from different locations to obtain a broad perspective of optimal care. Both Wendy Gross, MD, and Barbara Gold, MD, are such individuals. Dr. Gross is currently assistant professor of Anesthesia at Harvard Medical School and an attending anesthesiologist atthe Brigham and Women’s Hospital. She is currently the medical director of the Procedural Sedation Service and the Peri-Procedural Services in Cardiovascular Medicine and director of Non-OR Anesthesia Services at her hospital. Dr. Gold is currently associate professor of Anesthesiology and vice chair for Education at the University of Minnesota and medical director of anesthesia at FairviewHospital. She has been a leader in the area of ambulatory anesthesia and a former president of the Society of Ambulatory Anesthesia. Together, they have produced an issue which will help us deal with new challenges in our practice. Lee A. Fleisher, MD, FACC Department of Anesthesiology and Critical Care University of Pennsylvania School of Medicine 6 Dulles, 3400 Spruce Street Philadelphia, PA 19104,USA E-mail address: fleishel@uphs.upenn.edu (L.A. Fleisher)

Anesthesiology Clin 27 (2009) xiii doi:10.1016/j.anclin.2009.02.001 anesthesiology.theclinics.com 1932-2275/09/$ – see front matter ª 2009 Elsevier Inc. All rights reserved.

Anesthesia Outside the Operating Room

Preface

Wendy L. Gross, MD, MHCM Barbara Gold, MD Guest Editors

For the most part, anesthesiologists practicetheir specialty in the controlled setting of the operating room (OR). However, improved technology, escalating financial constraint, limited OR resources, and growing numbers of acutely ill patients create incentives for medical practitioners to perform procedures outside of the OR. Consequently, the need for deeper sedation, general anesthesia, and hemodynamic monitoring in non-OR venues has growndramatically. In many hospitals, the non-OR caseload is equal to that of the OR. Many non-OR procedures are performed with minimal to moderate intravenous sedation administered by registered nurses, however, an increasing number require more extensive medications and regimens administered by anesthesiologists. Not only is the volume of non-OR cases increasing, but the scope of non-OR proceduresrequiring anesthesia care is increasing as well. This evolution generates new challenges for medical interventionalists, anesthesiologists, and patients alike. As the practice of anesthesiology moves beyond the familiar domain of the OR, it enters the venue of medical specialists—such as invasive cardiologists, interventional radiologists, gastroenterologists, and oncologists. There are new obstaclesto overcome as the landscape changes. The articles herein have been compiled to help the practioner navigate the new landscape by examining the issues from multiple perspectives. This issue of Anesthesiology Clinics is divided into three sections, each of which scrutinizes the practice of anesthesiology in non-OR locations.

SECTION 1: FINANCIAL CONSIDERATIONS
This section discusses the...