Office-based surgery and anesthesia

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Health care delivery is undergoing a revolutionary change. It is focusing rapidly all over the world towards outpatient and home care. One of the most obvious results of these changes has been the relative explosion office-based surgery and anesthesia; however, these are not new concepts. Dentistry and office-based anesthesia have always been closely interwined. In 1844, two dentists, Wells and Morton, changed the practice of anesthesia firstly with the use of nitrous oxide and secondly with ether for tooth extraction. Thereafter, office-based surgery and anesthesia continued to evolve. In the past two decades, the rapid development of new surgical technologies and pharmaceuticals have facilitated the movement of more invasive surgical procedures and anesthesia to less invasive settings, such as the doctor's office. The most significant recent changes in health care are changes in the consumer, the practitioner and the provider. All are demanding high quality anesthesia and surgery care at a reduced cost. Articles describing almost every type of surgical and anesthetic techniques in the office can be found in the literature. However, the success of providing safe and cost-effective surgical and anesthetic care at an office depends on major issues, including adequate selection of the surgical procedure, complete preoperative assessment of the patient's state of health and adequate equipment and design of the unit. It is incumbent upon practitioners to make certain that the safety of the hospitals is not sacrified in the office setting. Health care has to be delivered as safely in the office as it would be elsewhere. Regulations and guidelines should be established in consultation with surgeons, anesthesiologists and administrators to ensure safe health care. These guidelines should be based on the specific type of surgery, the level of anesthetic required and the design of the office. This way the provision of adequate quality of care is ensured. Office-based anesthesia and surgery will no doubt continue to evolve because it is safe, pleasing and convenient for the patient and of low cost.

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