6.1 Introduction

With progressive refinement of cosmetic and reconstructive surgical techniques, the development of less invasive surgical procedures, and the gradual demographic shift of the world’s population toward the older age, the popularity of cosmetic and restorative treatments continues to increase. While more than 50% of all aesthetic surgeries are performed in the office [1], the majority of the newer noninvasive and minimally invasive cosmetic and restorative procedures are performed in the office setting. As a consequence of this shift toward less invasive procedures and greater officebased surgery, the surgeon has assumed a greater role in the selection and management of the anesthesia administered during the procedure.

Decisions relating to the preoperative evaluation, the selection of the anesthesia to be administered, the intraoperative monitoring, the postoperative pain management, and the discharge criteria, which were previously performed by the anesthesiologist or Certified Registered Nurse Anesthetist (CRNA), frequently become the responsibility of the surgeon. Evidence suggests that anesthesia-related deaths are significantly higher when the surgeon also administers the anesthesia [2]. Therefore, if the surgeon accepts the responsibility of the management of anesthesia, then it is incumbent on the surgeon to achieve an in-depth understanding of the concepts of anesthesia and to

G.D. Bennett

Department of Anesthesiology, Chapman Medical Center, 2601 East Chapman Ave., Orange, CA 92869, USA e-mail: dasseen@cox.net

adhere to the same standards of care that are applied to the anesthesiologist or the CRNA [3]. The following chapter should serve as an introduction to understanding the standards-of-care relating to anesthesia for the cosmetic surgeon.

6.2 Surgical Facility

When deciding where to perform surgical procedures requiring anesthesia, the surgeon should be aware that studies demonstrate a threefold mortality in surgeries performed at the office-based setting compared to similar surgeries performed at other facilities such as freestanding surgical centers or hospitals [4]. Most states in the USA require that the surgical facility be accredited by one of the regulating agencies if general anesthesia or enough sedative medication is used which could potentially result in the loss of life-preserving protective reflexes [5, 6]. All operating rooms where anesthesia is administered must be equipped with the type of monitors required to fulfill monitoring standards established by the American Society of Anesthesiologists (ASA) [7], and resuscitative equipment and resuscitative medications [8, 9]. A transfer agreement should be established with a nearby hospital in the event of an unplanned admission. Preferably, the surgical facility should have convenient access to a laboratory in the event of a stat laboratory analysis. Essentially, office-based surgical facilities should comply with the same standard-of-care as accredited outpatient surgical centers and hospital-based outpatient surgery departments.

Reprinted with permission of Springer