Anesthesia in Outpatient Facilities

Office-based Plastic Surgery—Evidence-based Clinical and Administrative Guidelines

“…Conscious sedation, characterized by the patient’s ability to self-maintain spontaneous respirations and airway protection, and local anesthesia can be considered in the OBS setting, including for facial and breast surgery and body contouring. 92–94 These techniques offer multiple advantages over general anesthesia, including shorter recovery, less PONV, improved cost effectiveness, and less equipment and personnel required for administration. Low-dose propofol is a good sedative in OBS because of its anxiolytic and amnestic properties and its manageable pharmacodynamics and side effects.…”

“…Given the nature of conscious sedation and local anesthesia, it is the surgeon’s responsibility to be aware of the patient’s comfort level and be in communication with the anesthesiologist. 92…”

“…Preoperative evaluations are necessary to maintain patient safety when administering sedatives, local, or general anesthesia. 24,92 The chosen anesthetic technique should be appropriate for both the patient’s overall health and the procedure. 26 The ASA Patient Selection Physical Status Classification System places patients into four categories of health and ability to tolerate anesthesia.…”

Ambulatory Sedation for Dental Procedures—Case of Cuenca, Ecuador

“…In pediatric dentistry, minimal pharmacological or non-pharmacological interventions are often not sufficient to achieve adequate comprehensive care, since factors such as the extensive treatment needs of the child, acute situational anxiety, age, limited cognitive functioning, long intervention times, physical disability, or medical conditions require deep sedation or general anesthesia to develop dental treatment safely [ 4 , 5 , 6 , 7 , 8 ]. In relation to adults, children have constantly changing anatomical, pharmacokinetic, and psychological differences; therefore, sedation aims to maintain safety, eliminate pain, reduce anxiety, and control behavior, allowing the planned intervention to be carried out [ 9 , 10 ].…”

“…Authorized bodies in the field such as the American Academy of Pediatric Dentistry (AAPD) [ 14 ] support the use of deep sedation or general anesthesia in the dental office, as long as it is administered by qualified personnel; among the benefits cited are early access to dental care, ease and efficiency in scheduling clinical intervention, reduction of administrative procedures, lower costs compared to surgical or hospital centers, decreased patient movement, and optimizing the quality of care [ 15 ]. It is necessary to point out that the AAPD suggests that these sedation or general anesthesia procedures be performed only if the patient’s orofacial risk is high; otherwise, it is recommended to use conventional procedures, since complications during the performance of the procedure are common and well documented [ 9 , 14 ]. In addition, the US Food and Drug Administration (FDA) in December 2016 announced that exposure to certain sedatives and general anesthetics may affect brain development in children under 3 years of age, especially in procedures lasting more than 3 h [ 16 ], a situation that has been discussed for several years, without definitive conclusions [ 17 ].…”