1. Role of Anesthesiologists/CRNA in an Office Interventional Suite
Krishna Jain MD, John Munn MD, Mark Rummel MD, Dan Johnston M.D, Syed Alam, MD
OEIS 2016

2. Disclosure
National Office Endovascular Labs LLC : President and CEO

3. Future of Vascular Surgery is in the Office*
“No anesthesiologist’s expense and minimal preprocedural expenses were incurred”
*Jain et al J Vasc Srg:2010;51:509-14

4. Evolution Dialysis cases Duration of Procedure Aortogram
Iliac angioplasty
SFA intervention
Tibial intervention
Radial approach
Tibial approach Increasing

5. Contraindications Patients>400 lbs High cardiac risk
Poor pulmonary function
Low pain tolerance

6. Definition of Anesthesia Levels*
Minimal sedation
Anxiolysis
Moderate/Sedation analgesia “Conscious sedation”
Deep Sedation/Analgesia
General anesthesia
Responsiveness
Normal response to verbal stimulation
Purposeful response to verbal or tactile stimulation
Purposeful response following repeated or painful stimulation
Unarousable even with painful stimulus
Airway
Unaffected
No intervention required
Intervention may be required
Intervention often required
Spontaneous Ventilation
Adequate
May be adequate
Frequently inadequate
Cardiovascular Function
Usually maintained
May be impaired
*Approved by ASA house of delegates and amended 2009

7. New York Law
Office-based Surgery is any Surgical or other invasive procedures performed by a physician, PA or Specialist assistant, outside of a hospital, diagnostic and treatment center, ambulatory surgery center or other Public Health Law article 28 facility in which moderate or deep sedation or general anesthesia is used.
Any sedation beyond minimal sedation requires accreditation.

8. State Regulations
Surgery/Anesthesia guidelines in Louisiana, North Carolina, Texas
Office anesthesia or surgery regulations in Alabama, Illinois, Mississippi, New Jersey, New York, Tennessee, Virginia

9. American Society of Anesthesiologist
Reliable Oxygen source
Adequate suction capability
Adequate anesthesia drugs
Adequate monitoring equipment
Sufficient electric outlets
Adequate lighting
Adequate space
Emergency cart
Staff trained to help anesthesiologist
Building and safety codes
Appropriate post anesthesia management

10. Reasons to use anesthesia service
Procedures are getting longer
Sicker patients can be done in the office
Patients with low pain tolerance
Increased safety
Quick recovery with the use of Propofol

11. Advantages to OBL Increased safety profile
May be able to decrease one full time registered nurse
May be able to increase volume

12. Disadvantages
Anesthesiologist may require more blood tests pre procedure
Every patient needs an intravenous line
Potential of cancellation
Patient gets one more bill

13. Satisfaction Our patients are more satisfied
We think we made the right decision