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 exceeding 300 lbs. (table limit) or with a Body Mass Index 37-40 will be done at Plastic and Hand Surgical Associates discretionarily following an anesthesia evaluation.
Patients with BMI over 40 will not be done at P&H with one specific exception - those hand cases that can be done under straight local in the event of block failure. Morbid obesity is defined as BMI>37.A BMI Calculator is available here.
[Note from John Siegle, Spectrum Liason:
BMI pts. 37-40 need to be cleared by anesthesiologist (at least a "drive by"). Regarding any exceptions made for BMI >40 pts., I urge you to only make exceptions for cases which will involve regional anesthesia, and where the case can be performed under straight local should the block fail. Carpel tunnel release, for example, might fall into this category whereas a palmar fasciectomy would not. Also, if one is performing a"drive by" but will not be doing the case, please try to contact the individual who will do the case to make sure they are in agreement. "Drive-by" evaluations will be done between cases. Please try to be flexible.]
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). Patients with BMI over 40 will not be done at P&H with one specific exception - those hand cases (CTR) that can be done under straight local in the event of block failure. No sedation or Xanax.
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