THE TOP 10 LIVING ANESTHESIOLOGISTS 2022

Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
email rjnov@yahoo.com
phone 650-465-5997

TheAnesthesiaConsultant.com presents its 2022 ranking of The Top 10 Living Anesthesiologists. These individuals made significant original contributions to the practice and/or education of anesthesiologists throughout the world. As a physician anesthesiologist who has attended to patients in the 1980s, 1990s, 2000s, 2010s, and now the 2020s, in both university and community settings, I’m uniquely qualified to identify and honor the leaders in our field over this time. 

Here’s the list:

David Gaba MD

#10. David Gaba MD, Stanford University School of Medicine. Dr. Gaba developed the anesthesia crisis simulator, and his group developed the Stanford Anesthesia Emergency Manual. Both are landmark contributions toward reducing medical errors by anesthesia providers and improving patient outcomes. Dr. Gaba has authored 242 publications in major medical journals.  He is a Professor at the Stanford University Department of Anesthesiology, Perioperative and Pain Medicine, and the Associate Dean for Immersive and Simulation-Based Learning at the Stanford University School of Medicine

James Eisenach, MD

#9. James Eisenach MD, Wake Forest University.  Dr. Eisenach served as Editor-in-Chief of Anesthesiology for 10 years from 2007-2016, and in 2016 became the President and CEO of the Foundation for Anesthesia Education and Research (FAER), a key organization supporting research in our field. Dr. Eisenach has authored 562 publications in major medical journals and is nationally renowned for his research on the mechanisms of pain.  Dr. Eisenach is a Professor of Anesthesia at Wake Forest University.

Robert Stoelting MD

#8. Robert Stoelting MD, University of Indiana. https://patientsafetymovement.org/speaker/robert-k-stoelting-md/   Dr. Stoelting is the author of the textbook Pharmacology and Physiology in Anesthetic Practice, co-author of the textbooks Basics of Anesthesia and Anesthesia and Co-Existing Disease, and co-editor of the textbook Clinical Anesthesia. During his 19 years as President of the Anesthesia Patient Safety Foundation, Dr. Stoelting was instrumental in developing and expanding the APSF as a leading publication in the anesthesia literature.  Dr. Stoelting is a Professor Emeritus and Past Chair, Department of Anesthesia, Indiana University School of Medicine (1977-2003).

Richard Jaffe MD

#7. Richard Jaffe MD PhD, Stanford University. Dr. Jaffe is the lead author/editor of the premier anesthesia textbook Anesthesiologist’s Manual of Surgical Procedures, first published in 1994. This textbook presented a new and original format, with surgeon authors describing all the common surgical procedures followed by anesthesiologist authors describing the preoperative, interoperative, and postoperative approaches to each type of case. This was the first anesthesia “recipe book,” and with each new edition (there have been six editions to date) it remains one of the best-selling anesthesia textbooks. Dr. Jaffe has also authored 130 publications in major medical journals. Dr. Jaffe is a Professor, Stanford University Department of Anesthesiology, Perioperative and Pain Medicine, and by courtesy, of Neurosurgery. 

Jonathan Benumof MD

#6. Jonathan Benumof MD, University of California San Diego.  Dr. Benumof was the main originator of the American Society of Anesthesiologists Difficulty Airway Algorithm, first published in 1996. The Difficult Airway Algorithm described pathways to safe airway management, and its application has saved countless lives that might have been lost to mismanaged airway disasters. He also single-authored the textbook Anesthesia for Thoracic Surgery as well as 311 publications in major medical journalsDr. Benumof is an Emeritus Professor of Anesthesiology at the University of California San Diego School of Medicine

Dr. Steven Shafer testifying at the Michael Jackson manslaughter trial

#5. Steven Shafer MD PhD, Stanford University.  Dr. Shafer’s area of expertise is the pharmacology of intravenous anesthetic drugs. He was the Editor-in-Chief of Anesthesia and Analgesia for 10 years and authored 293 publications in major medical journals, many of them the initial studies on the pharmacokinetics of propofol. He is currently the Editor-in-Chief of The ASA Monitor. Dr. Shafer appeared as an expert witness in the Michael Jackson manslaughter trial, in which Dr. Conrad Murray was convicted of the inappropriate administration of propofol in Jackson’s bedroom. Dr. Shafer is a Professor Emeritus at the Stanford University Department of Anesthesiology, Perioperative and Pain Medicine

Lee Fleisher MD

#4. Lee Fleisher MD, University of Pennsylvania.  Dr. Fleisher authored the textbooks Anesthesia and Uncommon Diseases, and Complications in Anesthesia, as well as 421 publications in major medical journals, with a concentration in the preoperative evaluation of the surgical patient. His most noteworthy contribution was the classic paper Preoperative Cardiac Evaluation for Noncardiac Surgery, published in 1992 in Anesthesia and Analgesia. This paper set the standards for how anesthesiologists should approach the preoperative cardiac evaluation of their patients. Dr. Fleisher was the long-term Chair of the Department of Anesthesiology and Critical Care (2004-2020), and the Robert Dunning Dripps Professor of Anesthesia at the University of Pennsylvania Health System. He is currently the Chief Medical Officer and Director of The Center for Clinical Standards and Quality at the Centers for Medicare & Medicaid Services (CMS), a part of the Department of Health and Human Services (HHS). 

Daniel Sessler MD

#3. Daniel Sessler MD, Cleveland Clinic. Dr. Sessler has authored an astounding total of 1089 publications in major medical journals, and has raised total extra-mural research funding of $65 million so date. Dr. Sessler is an editor for Anesthesiology and serves as a reviewer for more than 50 journals. He has given invited lectures at more than 350 institutions.  His papers have been cited more than 37,000 times, making him the world’s most published and cited anesthesiologist. Dr. Sessler is currently Professor and Chairman, Department of Outcomes Research, Anesthesiology Institute at the Cleveland, and Clinical Professor of Anesthesiology at Case Western Reserve University. 

Dr. Archie Brain and his invention, the LMA

#2. Archie Brain MB, London Hospital, Whitechapel, England. Dr. Brain is the British anesthesiologist who invented the laryngeal mask airway (LMA), which he patented in 1982. Dr. Brain’s objectives for the LMA were to provide a better method of maintaining a patient’s airway than by face mask, with the benefit that the LMA was less hemodynamically stressful than the insertion of an endotracheal tube. The LMA has been used over 300 million times worldwide in elective anesthesia and emergency airway management, and is one of the most significant anesthesia inventions in the last 50 years. The LMA Classic was sold by LMA International NV, a company which sold to Teleflex Inc in 2012 for $276 million.

Ronald Miller MD

#1. Ronald Miller MD. University of California San Francisco. Dr. Miller is best known as the initial lead author of Miller’s Anesthesia, the most widely used textbook of anesthesiology in the world, first published in 1981 and now in its Ninth Edition. https://anesthesia.ucsf.edu/news/ronald-d-miller-distinguished-professorship  Dr. Miller was the Chairman of Anesthesia at UCSF from 1983-2009,  and built what was arguably the finest anesthesiology department in the world, with a particular focus on research, as well as expanding the role of anesthesiologists in the pain clinic and in the intensive care unit.

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NOTE: This list does not include the inventor of the GlideScope, the first commercial video laryngoscope (developed in 2001 and an outstanding contribution to the field of anesthesiology), because Dr. John Allen Pacey, the inventor of the GlideScope, was not an anesthesiologist but a vascular and general surgeon at the University of British Columbia. 

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NOTE: This list of The Top 10 Living Anesthesiologists does not contain any females or diversity. All ten nominees are white males. Such was the state regarding the advances in our specialty over the past five decades. Future lists may honor females or diversity, depending on the state of career achievements over the coming years.

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THE NEW 2022 ASA DIFFICULT AIRWAY ALGORITHM

Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
email rjnov@yahoo.com
phone 650-465-5997

The American Society of Anesthesiologists (ASA) just published a 2022 update on their ASA Difficult Airway Algorithm Guidelines. The 2022 document is a revision of the 2013 publication “Practice guidelines for management of the difficult airway: A report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway.” The 2022 ASA Difficult Airway Algorithm Guidelines are 51 pages in total.

The most important changes are identified by examining the 2013 and the 2022 algorithms side by side. Let’s look at the 2013 flow chart algorithm and compare it to the 2022 flow chart algorithm below:

THE 2013 ASA DIFFICULT AIRWAY ALGORITHM

THE 2022 ASA DIFFICULT AIRWAY ALGORITHM

Note these major changes from 2013 to 2022:

  1. The top third of the 2022 algorithm lists factors which direct the anesthesiologist to perform awake intubation. The reason for this change is undoubtably the wisdom of utilizing awake intubation when a significant risk of a difficulty airway exists. There are minimal airway risks when a patient is awake, and the benefit of placing the endotracheal tube in a difficult airway patient while the patient is awake is immense. When we give mock oral board examinations to anesthesia residents at Stanford, and we describe to the examinee that the patient has a difficult airway, the answer of “I’d do an awake intubation” is hard to criticize and almost never leads to a catastrophe. In contrast, inducing general anesthesia prior to intubation in these patients can lead to a “Can’t intubate-can’t oxygenate” emergency, which can lead to a cardiac arrest and possible anoxic brain damage.
  2. The text highlighted in red in the 2022 document is both new and vital. The first of these is “OPTIMIZE OXYGENATION THROUGHOUT,” under the pathway INTUBATION ATTEMPT WITH PATIENT AWAKE, with the footnote 2Low- or high-flow nasal cannula, head elevated position throughout procedure. Noninvasive ventilation during preoxygenation. The message is to keep oxygen flowing via nasal cannula throughout airway management attempts to minimize hypoxia, and to keep the head elevated to maximize the functional residual capacity (FRC), which is the reservoir of oxygen in the patient’s lungs.
  3. LIMIT ATTEMPTS, Consider calling for help” is new and printed within a red box in the INTUBATION ATTEMPT AFTER GENERAL ANESTHESIA –> FAILED pathway. This is an effort to prevent repetitive unsuccessful intubation attempts from soaking up precious time, during which the brain is poorly oxygenated.
  4. LIMIT ATTEMPTS AND CONSIDER AWAKENING THE PATIENT” is new and printed in red in the NON-EMERGENCY PATHWAY under the “Ventilation adequate/intubation unsuccessful” pathway. This is again an effort prevent repetitive unsuccessful intubation attempts from soaking up precious time, during which the brain is poorly oxygenated.
  5. LIMIT ATTEMPTS AND BE AWARE OF THE PASSAGE OF TIME, CALL FOR HELP/FOR INVASIVE ACCESS” is new and printed in red in the EMERGENCY PATHWAY under the MASK VENTILATION NOT ADEQUATE, SUPRAGLOTTIC AIRWAY NOT ADEQUATE pathway. This is again an effort to prevent repetitive unsuccessful intubation attempts from soaking up precious time, during which the brain is poorly oxygenated.

These changes, printed or boxed in red, emphasize that the pace of difficult airway decisions is important. The duration of elapsed time is vital. When an anesthesia provider cannot intubate the patient and then cannot ventilate the patient, the oxygen level in the blood can plummet. There is a significant danger of anoxic brain damage within minutes. I’ve previously reviewed this topic in a 2019 Anesthesia Grand Rounds Lecture at Stanford, summarized in my article “Five Minutes to Avoid Anoxic Brain Damage.” The U.S. Library of Medicine website states that “Brain cells are very sensitive to a lack of oxygen. Some brain cells start dying less than 5 minutes after their oxygen supply disappears. As a result, brain hypoxia can rapidly cause severe brain damage or death,” and “Time is very important when an unconscious person is not breathing. Permanent brain damage begins after only 4 minutes without oxygen, and death can occur as soon as 4 to 6 minutes later.”

The sentence “Be aware of the passage of time, the number of attempts, and oxygen saturation” appears more than once in the 2022 Difficult Airway Algorithm Guidelines article, and is a key point for all anesthesia providers who encounter a difficulty airway emergency.

In my roles as an anesthesia quality assurance reviewer or a medical-legal expert consultant, I’ve seen this issue arise multiple times. Even though anesthesia providers believe they are following the Difficult Algorithm accurately, they are doing things too slowly, and they waste too much time. Once it’s clear that a “Cannot intubate-cannot oxygenate” scenario is occurring, the time clock is running, and the anesthesia provider must not only do the correct thing but he or she must do the correct thing without undue delay. The necessary procedure may be as invasive as a cricothyroidotomy/front of the neck access via the scalpel-bougie-endotracheal tube approach.  

The five points listed above are the major changes in the algorithm. In addition, the new 2022 article includes a Pediatric Difficult Airway Algorithm and an approach to Extubation of the Trachea in a Difficult Airway Patient. Other important quotes from the 2022 article include (bold emphasis added):

  1. “The consultants and members of participating organizations strongly agree with recommendations to perform awake intubation, when appropriate, if the patient is suspected to be a difficult intubation and difficult ventilation (face mask/supraglottic airway) is anticipated.”
  2. “Meta-analyses of randomized controlled trials comparing video-assisted laryngoscopy with direct laryngoscopy in patients with predicted difficult airways reported improved laryngeal views, a higher frequency of successful intubations, a higher frequency of first attempt intubations, and fewer intubation maneuvers with video-assisted laryngoscopy.”
  3. The footnote (7) for alternative difficult intubation approaches states: 7Alternative difficult intubation approaches include but are not limited to video-assisted laryngoscopy, alternative laryngoscope blades, combined techniques, intubating supraglottic airway (with or without flexible bronchoscopic guidance), flexible bronchoscopy, introducer, and lighted stylet or lightwand. 
  4. “A randomized controlled trial comparing a videolaryngoscope combined with a flexible bronchoscope reported a greater first attempt success rate with the combination technique than with a videolaryngoscope alone.”
  5. When appropriate, refer to an algorithm and/or cognitive aid.” 

AUTHOR’S NOTE: I’d suggest that the Stanford Emergency Manual of cognitive aid algorithms for anesthesia and ACLS emergencies be onsite at all anesthetizing locations. 

I’d also recommend that the 2022 ASA Difficult Airway guideline algorithm be onsite at all anesthetizing locations.

Every anesthesia professional will encounter patients with difficult airways—this is one of the most important and most feared situations in our specialty. Commit the 2022 ASA Difficult Airway Algorithm to memory. Use awake intubation when you’re concerned about the potential of a “Cannot intubate-cannot oxygenate” scenario. And if you’re in the middle of a difficult airway emergency, call for help and be aware of the passage of time, the number of attempts, and the oxygen saturation. Don’t let an excessive number of minutes elapse without regaining oxygenation of your patient.

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READ ABOUT RICK NOVAK’S FICTION WRITING AT RICK NOVAK.COM.

EMERGENCY AT A SURGERY CENTER

Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California.
email rjnov@yahoo.com
phone 650-465-5997

You’re the anesthesiologist assigned to a freestanding ambulatory surgery center (ASC). Are you and the facility prepared for an emergency at a surgery center? Let’s examine this case study:

You meet your first patient of the morning, a 75-year-old female scheduled for lateral epicondylitis release surgery on her right elbow.  You review her medical record and interview her. You discover she had her aortic valve replaced with a small metal valve two years earlier. She is active, although she does experience mild shortness of breath on walking stairs. She is obese, weighing 200 pounds, with a BMI=35. She is on no medications. On physical exam, her vital signs are normal, her lungs are clear, and her heart exam is positive for the clicking sound of a mechanical valve and a 2/6 systolic murmur. She has a thick neck and a large tongue. The surgeon says he will only need to operate for 15 minutes. The patient refuses a regional nerve block, so she’ll need to be asleep.

You attach the standard vital sign monitors, preoxygenate the patient, and induce anesthesia with 150 mg of propofol, 50 micrograms of fentanyl, and 40 mg of rocuronium. You intubate her trachea with a 7.0 tube without difficulty, and place her on a ventilator delivering 1.5% sevoflurane and 50% nitrous oxide.

The patient’s arm is prepped and draped. The surgeon injects 2% lidocaine at the skin incision site, and the surgery begins. Vital signs remain normal with BP=110/70, P=80, and oxygen saturation=99%. The surgery concludes after 17 minutes. You discontinue the sevoflurane and reverse the paralysis with sugammadex. The patient’s blood pressure increases to 150/100 within three minutes. Three minutes later the oxygen saturation drops to 80% and thick frothy fluid bubbles into the endotracheal tube and the circle breathing hoses which connect the patient to the anesthesia machine. The blood pressure is now BP=180/120.

You call for help and attempt to suction the frothy fluid out of the breathing tubes. You listen to the lungs and hear loud rattling rales. You assess that you’re dealing with pulmonary edema (excess fluid in the lungs). The patient’s oxygen saturation drops to 70%. 

A second anesthesiologist responds to your call for help and arrives in the room. You explain what is going on, and while you do, the oxygen saturation becomes unmeasurable and the blood pressure machine fails to give any reading. Your colleague suggests you administer 20 mg of Lasix (furosemide) as a diuretic, and he injects this for you. You continue to ventilate the patient with 100% oxygen, and continue to suction copious fluid out of the patient’s lungs. The ECG monitor descends into a slow agonal rhythm, and when you check the carotid artery at the patient’s neck, there is no pulse. You call a Code Blue and begin CPR compressions on the patient’s chest. After thirty minutes of Advanced Cardiac Life Support (ACLS) drug administration, the pulses have not returned. You have no other therapies to offer, and the patient is declared dead.

Acute pulmonary edema on a chest X-ray

Did this have to happen? No, it did not. In a parallel universe with more competent clinicians, let’s look at how this patient should have been handled:

  1. First off, this case was inappropriate for a freestanding outpatient surgery center. This freestanding outpatient surgery center was located miles from the local hospital, and the hospital resources of an intensive care unit (ICU), respiratory therapists, arterial blood gas analysis, and chest X-rays were not available. The surgery was trivial enough—a brief procedure on the elbow—but the patient had a medical history which was too complex to approve a general endotracheal anesthetic at a freestanding ASC. Typically patients who have had a successful cardiac valve replacement are much improved after their surgery, and complaints of shortness of breath or extreme fatigue—symptoms of inadequate cardiac function—are absent. A 75-year-old patient who complains of shortness of breath on exertion was a poor candidate for anesthesia at an ASC. A pre-operative cardiology consult was indicated, and would likely include an echocardiogram and a stress test. In our parallel universe, the echocardiogram ordered by the cardiologist revealed a small aortic valve diameter—less that one centimeter—and a dilated left ventricle with an ejection fraction (LVEF) of 35% (a severely abnormal value, as the normal left ventricle can eject more than 50% of its volume). This patient with a low LVEF needed to have her surgery postponed until her cardiac function was improved via medications or a further surgical cardiac intervention was done. After that, when and if this elbow surgery ever does occur, it would need to be done in a hospital setting.
  2. What if the anesthesiologist did not adhere to #1 above, and the anesthetic led to pulmonary edema as described above? How could the anesthesiologist better manage the emergency? All acute medical care is managed by A-B-C, or Airway-Breathing-Circulation. In this case the Airway tube was in place. The Breathing was being done by the ventilator, but the breathing tube was occluded by pulmonary edema fluid. The treatment to improve the Breathing was both active suctioning to clear the airway of fluid and medical treatment to reverse the cause of the increased fluid. Diagnosis of the Breathing and Cardiac problems was as follows: discontinuation of anesthesia in this patient, who still had a breathing tube in her trachea as she awakened, stimulated markedly increased blood pressure –> the left ventricle could not eject against this high pressure –> this led to acute left heart failure with resulting backup of fluid into the lungs –> this caused pulmonary edema and dropping oxygen saturation. (Because of her airway anatomy, she was not a candidate for a deep extubation.) Treatment for both the Breathing problem and the Cardiac problem was an emergency afterload reducing drug such as nitroprusside. Every ASC must have a Code Blue cart with emergency drugs and equipment, and the anesthesiologist must call for the cart. He or she instructs one of the RNs to prepare a 250 ml bag of nitroprusside and to attach it to an intravenous infusion pump.
  3. We anesthesiologists are only as good as our monitoring devices. When the oximeter reports very low readings and the BP cuff stops working, we are in big trouble. Anesthesiologists cannot safely administer a potent intravenous infusion such as nitroprusside without an accurate second-to-second monitor of the patient’s blood pressure. One of the anesthesiologists quickly places an arterial line catheter in the left radial artery at the wrist. The arterial line is connected to the monitoring equipment, to reveal that the blood pressure is 240/140, for a mean blood pressure (MAP) of 173 mm Hg. The anesthesiologists connect the nitroprusside drip to the peripheral intravenous line, and infuse the drug to decrease the blood pressure to 140/80 (MAP=100) within minutes. The frothing fluid in the breathing tubes clears, and the oxygen saturation returns to 100%. 
  4. The anesthesiologists then place a central venous catheter in the right internal jugular vein and transfer the nitroprusside infusion to the central line. They titrate small doses of fentanyl and Versed into the peripheral IV line to sedate the patient because immediate extubation is not appropriate, and prepare to transfer the patient via ambulance to the nearest hospital ICU. The original anesthesiologist accompanies the patient in the ambulance to the ICU, while continuing to monitor the patient’s vital signs and manage the blood pressure, sedation, ventilation, and oxygenation.
  5. The patient’s sedation is discontinued the next morning in the hospital ICU, and she is extubated safely. She has no brain damage or cardiac damage. The anesthesiologist visits her that afternoon, and converses with her as she eats her lunch. She has questions about how this could have happened, and he answers each question honestly.

There are multiple take-home messages from this case study:

  1. The preoperative screening of patients at a freestanding ASC is crucial. No one wants to have a Code Blue or a near-Code Blue, miles away from any hospital. Surgery centers manage preoperative screening in various ways, but most community ASCs do not run an in-person preoperative anesthesia clinic. At our ASC, a preoperative caller contacts each patient two days prior to their scheduled surgery, and fills out a comprehensive history form based on the patient’s answers and any medical tests and/or consults available on that patient. If there are positive answers regarding important medical issues such as shortness of breath, chest pain, heart disease, obstructive sleep apnea, morbid obesity, chronic kidney or liver disease, cancer, or previous transplants, then the preoperative caller refers the case to the Medical Director. The Medical Director makes the decision whether the patient is appropriate for the scheduled surgery. If the patient is not appropriate, the case is cancelled two days ahead of time.
  2. If an acute respiratory or cardiac emergency occurs at an ASC, the first move is to call for help from a second anesthesiologist. Two minds and four hands are a better solution. The registered nurses bring a copy of the Stanford Emergency Manual into the room, as well as the code cart which includes the emergency drugs and monitoring equipment.
  3. In a true emergency, diagnosis and treatment must occur within minutes. No anesthesiologist wants to be the doctor who “draws a blank” when their patient is trying to die right in front of them. Stanford’s Dr. David Gaba pioneered acute anesthesia simulator training to improve anesthesiologist performance in emergency settings. You may inquire whether such simulations are available in your geographic area.  
  4. Always manage acute medical emergencies as A-B-C, or Airway-Breathing-Circulation, in that order. In this case the improvement in Breathing required suctioning and afterload reduction, and the improvement Cardiac required arterial line monitoring and afterload reduction.
  5. Realize that short simple surgeries exist, but some short simple surgeries on sick patients present significant anesthetic risks. The anesthesiologist must assess all medical risks and not be swayed by a surgeon who insists this will be “just a short simple case.” If an anesthesiology complication occurs, that surgeon will not likely be blamed, nor will he or she come to your defense. It will be “the anesthesiologist’s fault.”
  6. Every ASC must be prepared for acute unexpected emergencies. The code cart must be stocked with ACLS medications and monitoring equipment for arterial and/or central lines. The ASC should ideally have a copy of the Stanford Emergency Manual, and all drugs and equipment listed in that manual should be available, even though it is not a hospital setting.
  7. It’s important for ASCs to conduct mock-Code-Blue drills on a yearly basis so that staff is prepared when a real emergency occurs.
  8. Depending on cost, an ASC may choose to stock a nitroglycerin drip or a newer potent vasodilator medication such as Cleviprex (clevidipine) rather than nitroprusside in their code cart.
  9. Ideally, anesthesiologists who work at ASCs should also have medical staff privileges at an acute care setting in a hospital, and be performing anesthetics on sicker hospitalized patients there. If an anesthesia provider’s practice is reduced to only healthy patients for outpatient surgeries, that anesthesia provider may become less than competent if a patient develops an emergency in a surgery center.
  10. In case of an emergency at a surgery center, your goal is to stabilize the patient and transfer the patient to the nearest hospital as soon as it is safely possible. The hospital resources of an ICU, respiratory therapists, radiology, cardiology consultation, and a full laboratory service including arterial blood gas analysis are invaluable.

For those readers who are surgical patients, let me reassure you that the vast majority of patients cared for at freestanding ASCs have no anesthesia complications, and many ASCs are staffed by competent anesthesiologists and nurses prepared to save you in the rare event that something goes awry before, during, or after your outpatient surgery.

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The most popular posts for laypeople on The Anesthesia Consultant include:
How Long Will It Take To Wake Up From General Anesthesia?
Why Did Take Me So Long To Wake From General Anesthesia?
Will I Have a Breathing Tube During Anesthesia?
What Are the Common Anesthesia Medications?
How Safe is Anesthesia in the 21st Century?
Will I Be Nauseated After General Anesthesia?
What Are the Anesthesia Risks For Children?

The most popular posts for anesthesia professionals on The Anesthesia Consultant  include:
10 Trends for the Future of Anesthesia
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12 Important Things to Know as You Near the End of Your Anesthesia Training
Should You Cancel Surgery For a Blood Pressure = 170/99?
Advice For Passing the Anesthesia Oral Board Exams
What Personal Characteristics are Necessary to Become a Successful Anesthesiologist?

READ ABOUT RICK NOVAK’S FICTION WRITING AT RICK NOVAK.COM.