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1. ANESTHESIOLOGY FOR ENT
SURGERY IN THE FREE

2. WHAT ARE AMBULATORY
SURGICAL CENTERS?
•A growing number of patients are undergoing same-day surgery
and receiving anesthesia services as an outpatient
•Patients tend to be more satisfied with their operation when done
at an ambulatory surgery center (ASC)
• Can dramatically lower medical costs without any significant
difference in complication rates
•ASCs have transformed the outpatient experience for millions of
Americans by providing high quality care while resulting in
positive patient outcomes.

3. ENT PROCEDURES AT AN ASC
•Many ear, nose, and throat (ENT) procedures are performed
safely in free standing ASCs, including laryngoscopy,
tonsillectomy and adenoidectomy, endoscopic sinus surgery,
rhinoplasty, tympanostomy, tympanoplasty, and mass excision
or biopsy.
•Types of anesthesia performed at an ASC
• General anesthesia which involves complete loss of
consciousness, sensation of pain, and ability to protect one's
airway.
• Monitored anesthesia care or sedation, depending on the
location and type of surgery
•Many of these procedures are completed in less than 1-2 hours,
making them suitable for an ambulatory setting.

4. SPECIAL CONSIDERATIONS
FOR ASCS
•Special anesthetic considerations for ENT cases include
• Sharing a potentially difficult airway with the surgeon
• It is important for the surgery and anesthesia teams to have a mutual
understanding of the plan for airway management, muscle relaxation,
patient positioning, post-operative pain and nausea/vomiting management,
and patient-specific concerns.
• Special endotracheal tubes with smaller sizes may be necessary, and awake
fiberoptic intubation may be indicated for an anticipated difficult airway.
• Nasal intubation may be preferred or necessary versus oral intubation for
surgical access reasons.
• Securement of the tube is essential given that the patient is usually
positioned 90-180 degrees away from the anesthesiologist, preventing
immediate access to the airway should movement of the tube or extubation
occur.
• Discussion of an airway management back up plan is
necessary for every case, should an emergency arise,

5. ANESTHESIA AT AN ASC
•Anesthesia services at an ASC are comprehensive and
include an anesthesiologist performing the preoperative
evaluation, intraoperative management, and immediate
postoperative care with discharge planning.
•Per the guidelines of the American Society of
Anesthesiologists, a physician anesthesiologist must
supervise all phases of anesthesia care at an ASC, and
personnel trained in advanced resuscitative techniques
should stay until every patient is discharged.
•In rare cases, a patient may need to be transferred to a
nearby hospital for management of serious
complications

6. CAN ALL ENT PROCEDURES
BE DONE AT AN ASC?
•Not all ENT surgeries can be performed as an outpatient,
and the appropriate surgical setting must be carefully
considered on a case by case basis during the
preoperative evaluation.
• The American Academy of Otolaryngology-Head and
Neck Surgery (AAO-HNS) supports general standards for
surgical procedures that may be appropriately performed
in an ASC setting, and general exclusions include
procedures that involve expected extensive blood loss,
major or prolonged invasion of body cavities, direct
involvement of major blood vessels, or are emergent or
life threatening in nature

7. BENEFITS OF UTILIZING AN
ASC
• For the anesthesia providers and surgeons, the ASC
setting offers efficient quality care, convenience, and
patient satisfaction, allowing physicians to focus on a
small number of processes in a single setting while
maximizing patient-doctor interaction.
•ASCs provide a responsive environment tailored to
individual patient needs as well as more precise control
over scheduling with fewer delays and rescheduled
procedures, reducing unnecessary health care costs.
•Overall, ASCs represent a positive trend in health care,
with increasing outcomes in patient satisfaction and
safety track records.

8. To learn more about our comprehensive anesthesia
services, visit us at
www.xenonhealth.com