Chapter 69
- Anesthesia at Remote Locations
- Paul E. Stensrud
Anesthesiologists are increasingly being asked to provide anesthetic
care to patients at locations outside the operating suite. Such locations include
radiology suites, cardiac catheterization laboratories, and psychiatric units. Care
must be provided in these areas because of patient need and the logistic constraints
of specialized equipment available only in such areas of the hospital, such as computed
tomographic (CT) scanning and magnetic resonance imaging (MRI) machines. When providing
care at such locations, anesthesiologists must maintain the same high standard of
anesthetic care provided in the operating suite.[1]
The anesthetizing location must be surveyed by the anesthesiologist to determine
whether anesthetic care can be safely delivered in that location before the delivery
of care.[2]
The requirements for anesthesia and
the patient's underlying condition do not vary merely because of location, but the
conditions under which the anesthetic care is delivered may vary greatly because
of the space and equipment available in these locations. Large, mobile pieces of
radiologic equipment, radiation hazards, intense magnetic fields, paramedical personnel
not familiar with the anesthesia team, and other factors may make the delivery of
quality anesthetic care problematic.
Guidelines for anesthetic care delivered outside the operating
suite have been developed by the American Society of Anesthesiologists (ASA).[3]
The 1994 Guidelines for Non-Operating Room Anesthetizing Locations
include recommendations for (1) a reliable oxygen source with backup; (2) a suction
source; (3) waste gas scavenging; (4) adequate monitoring equipment to meet the standards
for basic anesthetic monitoring and, in addition, a self-inflating hand resuscitator
bag; (5) sufficient safe electrical outlets;
(6) adequate patient and anesthesia machine illumination with battery-powered backup;
(7) sufficient space for the anesthesia care team; (8) an emergency cart with a defibrillator,
emergency drugs, and other emergency equipment; (9) a means of reliable two-way communication
to request assistance; and (10) compliance of the facility with all applicable safety
and building codes. It is the responsibility of the anesthesiologist providing care
to ensure that the anesthetizing location in which that care is delivered meets all
applicable standards.
