MEC is a free standing ambulatory center which provides a wide range of eye services to patients from Maine and New Hampshire. In 1987 MEC became the first medical practice in the state of Maine to have a Medicare certified ambulatory Surgical Center. It is housed on the second floor of a former shoe factory built in 1864. The rest of the building comprises physician offices, exam rooms, waiting rooms, etc. MEC is currently looking for a more spacious facility.
MEC provides a full range of anterior segment service (cataracts, corneal transplants, glaucoma) and ocular plastic lid procedures.
Retina cases are done The Scarborough Surgical Center, as are all cases requiring general anesthesia. There is one operating room.
Theresa Kudlak MD: pager 741-1900, cell 831-5641
- Telephone Switchboard: 774-8277
- Direct Line to pre-op area: 523-5641
- There is no telephone in the OR
- Maria Pitas CST, ASC Director: #400-1835
- Faye Hougaz RN Nursing Coordinator
- Jeffrey Berman MD Medical Director MEC
- Dick McArdle CEO
- Coverage is generally Monday through Friday
- Cases start at 0800, except on Thursday when start time is 0815 to accommodate our morning conference. Occasionally there will be a later start time.
- Cases vary from half hour (cataract) to two hours (oculoplastic cases).
- The OR team breaks for lunch, about half hour, at variable times between 1130 and 1300 depending on the schedule.
- PARKING: we are asked to park on the street; the parking lot surrounding the building is reserved for patients. However, I have parked there in a pinch. You will be issued a MEC sticker for your car
- LOCKER: there are male and female locker rooms,with bathrooms and a supply of scrubs
- LUNCH FACILITIES: there is a kitchen with refrigerator, microwaves, free coffee, instant hot water. BRING YOUR LUNCH.
- COMPUTER, PHONES: very limited computer access. You may bring your laptop; wireless network is available (access code is on the anesthesia cart). Your cellphone will work in the facility.
- Daily case schedule: A copy of the schedule for the day will be printed and left on anesthesia cart.
- Billing: Separate the billing sheet and place in wall slot above the desk in pre-op (The slot for anesthesia billing sheets can also be used for sending interoffice mail to the SMG office.)
- QA/Data sheets: are linked to the Anesthesia Record and should be completed and left at the desk for nursing data entry.
- Chart Assembly: Anesthesia record and consent will be in the chart. The patient will already have signed the consent form, but will need to initial the form after talking to you. The pre-anesthesia record has been designed to accommodate up to three procedures.
- Policies and procedures related to anesthesia service at the facility are available in Maria Pitas’ office.
- Policies related to waste management are in the bottom drawer of the anesthesia cart.
Anesthesia Cart: Stocked bluebell cart should contain all supplies needed, including medications, airway supplies, IV supplies, etc.
Ordering/Stocking: MEC staff will order supplies and restock the cart after each day's use, and mid-day if necessary.
Controlled Drugs: Issued at start of day by RN; usually Alfenta and Versed. Fentanyl is available. Keep track of use in 2 books provided. At days end, tally drug usage with RN
Suction: No wall suction, only portable units. There is a unit for use in the procedure room and in the recovery area.
Code Cart: Emergency cart is kept in pre/post op area; regularly checked and maintained by the MEC nursing staff. Includes a defibrillator. Also there are two AEDs in the building
Monitors: portable monitor on stand, including side-stream ETCO2
Infusion Pump: there are no infusion pumps
Note: there is NO anesthesia machine or ventilator. Anesthesia technique is expected to typically be conscious sedation with spontaneous ventilation. If positive pressure ventilation should be required, an Ambu bag is on the cart.
- The OR staff will transport the patient into the OR (you may also do this) and will usually help you attach monitors unless they are busy.
- RN positions patient on eye stretcher.
- The staff restocks the cart daily. If you need something just ask.
- MEC physician makes initial determination to do the case at MEC. No preoperative testing is required. Patients are commonly ASA 3 and have many co morbidities. There is no information from PCP.
- The patient fills out a pink history preop sheet, and that is the primary source of medical history and medications.
- There is no 12 lead EKG available.
- If you feel that the patient should not undergo surgery at MEC (chest pain, new onset A fib, deteriorating physical status) you may cancel the surgery. Nursing will arrange transport to ED by ambulance.
- Pre-Anesthesia instructions: Patients selected for anesthesia will receive NPO instructions as follows:
- no solids after midnight and
- discontinue clear fluids 3 hrs prior to scheduled procedure.
- Admission: MEC nursing staff will admit the patient and complete the nursing admission sheet which includes medication list, allergies, brief review of systems.
- Start IV: IV's will be started by nursing staff, usually on right side. No infusion is started
- Obtain controlled drugs: MEC Nursing staff will provide controlled drugs. Tally is done at end of day.
- Transport of patients: MEC staff will assist with transport of patients
- Identify Patient and perform "time-out" prior to start of procedure.
- Assist with positioning and comfort: MEC staff will assist with patient positioning and comfort, and application of monitors and oxygen.
- Assist during procedure if needed: MEC staff will be present and available to provide any additional needed assistance to the anesthesiologist.
- Provide Post-Anesthesia care: Phase 2 care will be provided according to ASA and ASPAN guidelines
- There is no Phase 1 at MEC as there is no GA.
- Ophthalmologist is responsible for discharge. All post-anesthesia patients must have a driver and are given specific discharge instructions.
Suggested Anesthesia Technique:
- Interview patient in admitting/recovery bay. Make it clear that patient will be awake during procedure and that pain will be controlled jointly by surgeon and anesthesiologist. Have patient initial consent.
- I usually give my dose of narcotic in the holding area to allow it time to work, followed by Versed and/or a whiff of propofol in the OR.
- Typical doses:
- Alfenta: 150 to 500 depending on age and health of patient.
- Versed 1-2 mg.
- Propofol 20-40 if needed.
- Regional Anesthesia and Eye Surgery, Anesthesiology Nov 2010