A significant factor in determining good patient outcome at Outpatient Surgical Centers is proper patient selection. The following criteria have been developed to assist in proper patient selection.
1. Patients with BMI over 40 must been seen and evaluated by an anesthesiologist (complete a preop sheet). Only patients who are otherwise healthy and have a normal airway should be accepted for surgery.
If the patient is not disease free (no hypertension, CAD, DM, smoker, PVD etc.) or the airway assessment is anything except a Class I, with 4cm mouth opening and FROM of the neck, the patient should be referred to an alternative facility for anesthetic and surgical care. (Mary Neal MD, Sept 2004)
2. Patients with untreated or inadequately treated coronary disease. Included in this group are patients with unstable angina (New onset with frequency>3/day, chronic stable angina which has increased in frequency, and angina at rest).
3. Patients with pacemakers and AICD's whose surgery cannot be performed without a Bovie (use of bipolar cautery is acceptable).
4. Asthmatics under no or poor control to receive general anesthesia. In this category are patients actively wheezing despite inhaler therapy. Regional anesthetics can be performed as long as the surgeon understands that nothing more than a block will be offered.
5. Sleep apnea patients who use a positive pressure breathing device (i.e. nasal CPAP).
6. COPD patients who are oxygen dependent or known CO2 retainers. In addition patients short of breath at rest, or with 1 flight of stairs (or equivalent exertion).
7. Pediatric patients under the age of seven.
8. Patients with known or high risk of Malignant Hyperthermia.
9. Patients with a history of a Difficult Airway or have clinical features which suggest that airway management could be a problem should have an Anesthesiologist Consultation prior to the day of surgery.
10. Patients with documented pseudocholinesterese deficiency or abnormalities will be referred to a hospital or other facility that has the capability of post-operative ventilation and respiratory support. Although the risk of airway emergency requiring succinylcholine may be low, the possibility of this happening is real neveretheless.