Office-based surgery: expanding the role of the anesthesiologist.

Office-based anesthesia (OBA) has developed in the United States as an important field for the anesthesia provider. Both the numbers and types of procedures performed in offices around the country have steadily increased, as has the invasiveness of these procedures. New anesthetic considerations arise. For example, most training programs have not addressed this area of practice. Indeed many practitioners are unfamiliar with practice outside the hospital operating room setting. Information as to how to provide quality care in a location where one may be the sole anesthesiologist must be readily available. Many of the safety mechanisms we take for granted in a hospital setting are often not present in a surgical office, and it becomes the responsibility of training centers to help in establishing standards. As the 'safety' of many surgical offices where anesthesia care is provided has been challenged, medical societies have begun to issue recommendations as to the standards of care that should exist. Different anesthetic techniques are also emerging that are appropriate to the office setting. But as office-based anesthesia continues to mature as a specialty, we the anesthesia providers, must be proactive in establishing guidelines and recommendations to ensure safe practice.