Gastric Banding and the Surgicenter

Discussion in 'Anesthesiology' started by turnupthevapor, Dec 27, 2008.

  1. turnupthevapor

    10+ Year Member

    Joined:
    Oct 7, 2008
    Messages:
    158
    Likes Received:
    23
    Status:
    Attending Physician
    Our surgeons want to start performing some gastric banding at one of our surgicenters.

    Only problem is it is at a place with only 1 anesthesiologist. There will be no one around to help with the induction. What is your experience with these patients in an outpatient facilty? One bad outcome I would imagine could sink the facility!

    I was thinking we should have a glidescope there, cpap for RR, etc. My major concern is only one anesthesiologist there...4 hands are definatley better than 2.


    whats your thoughts?:D

    Thank you
     
  2. toughlife

    toughlife Resident
    5+ Year Member

    Joined:
    Sep 11, 2004
    Messages:
    1,836
    Likes Received:
    3
    Status:
    Resident [Any Field]
    A difficult airway cart is definitely indicated. Glidescope and noninvasive ventilation equipment also key to make your life easier.
     
  3. pgy13

    pgy13 Junior Member
    10+ Year Member

    Joined:
    Sep 28, 2005
    Messages:
    126
    Likes Received:
    3
     
  4. cchoukal

    cchoukal Senior Member
    Moderator 10+ Year Member

    Joined:
    Jul 10, 2001
    Messages:
    2,015
    Likes Received:
    160
    Status:
    Attending Physician
    a difficult airway cart, glidescope, and cpap machine all sounds really expensive. is there a financial incentive for the anesthesia group to add these cases to the center? will you ever recoups these capital expenses by doing these cases?
     
  5. zonker1

    Removed

    Joined:
    Dec 26, 2008
    Messages:
    2
    Likes Received:
    0
    Status:
    Pre-Health (Field Undecided)
    I would think that by avoiding even one anoxic event due to cannot intubate/cannot ventilate the costs will be more then recovered.
     
  6. drmwvr

    10+ Year Member

    Joined:
    Dec 2, 2008
    Messages:
    493
    Likes Received:
    186
    Status:
    Non-Student
    It seems to me that the issues in the or would be the same for any unexpected difficult airway. Obese pts have outpatient surgery for things other than lap banding and, unless the truely massive (500-600# or so?) are candidates, my experience is that their airways are no more difficult than what you would expect to find generally. Anticipated diff airways would be treated as such as with any procedure. Clearly, some comorbidities would disqualify for an ASC. I agree, the issue lies primarily in recovery. That would be the deal breaker.
     
  7. Bertelman

    Bertelman Maverick!
    10+ Year Member

    Joined:
    Feb 11, 2006
    Messages:
    4,191
    Likes Received:
    10
    Status:
    Attending Physician


    Don't center-justify your text. It's more difficult to read.

    :p
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  8. ssmallz

    ssmallz California Dreamin
    10+ Year Member

    Joined:
    Sep 25, 2008
    Messages:
    666
    Likes Received:
    66
    Status:
    Fellow [Any Field]
    I don't see how these cases can be done w/out those tools. We have a surgeon in our program who must do 8-12/week. Whenever we're in that room a glidescope or some other difficult airway kit is a must. Its saved our butt a bunch of times. FWIW his patients always stay overnight in the hospital and sometimes you'll find a coupla unexpected post op complications.
     
  9. Pilot Doc

    Pilot Doc SDN Angel
    Moderator Emeritus 15+ Year Member

    Joined:
    Mar 6, 2002
    Messages:
    1,649
    Likes Received:
    7
    Status:
    Resident [Any Field]
    Sure, but the other option is to avoid the capital expenditure by not performing those cases at the surgicenter.
     
  10. turnupthevapor

    10+ Year Member

    Joined:
    Oct 7, 2008
    Messages:
    158
    Likes Received:
    23
    Status:
    Attending Physician
    Good thoughts everyone!

    Bertelman is this better?:laugh:
     

Share This Page