Where Is Anesthesia Performed?
Operating rooms, treatment rooms, and intervention radiology suites are beginning to
look more similar than ever. Historical functions of the different areas and physician specialties
are blending, making formerly clear lines quite hazy. Patient flow through the hospital’s
multifaceted care units must be carefully planned. Preparing and recovering a
surgical day-care patient (rather than one from general surgery) will put significantly different
demands on support systems and staffing. The hospital cannot afford bottlenecks
that result with unnecessary delays in surgical, imaging, or other expensive care areas.
For various reasons, doctors and patients alike express interest in providing anesthesia
at remote locations (out of the operating room) of the hospital. This poses significant risks
and unique challenges in planning, supporting, and actually meeting the demand. These
remote sites most often were not designed with anesthetizing-location-facility requirements
in mind. Details of facility criteria are discussed elsewhere in this handbook (see
Smith et al., Chapter 89). Reliable supplies of oxygen and suction, along with adequate
electrical power and lighting, are key components. The lack of any of these can negate
further discussion. If facility requirements are met, but physical space is an issue, the
anesthesiologist, machine, and supplies are often crowded into an uncomfortable corner.
From a user’s perspective, they are away from the space to which they have grown accustomed.
People must be extra vigilant when they are out of their normal element, as supplies
and other things are not where they are expected to be. More importantly, support
personnel are not immediately available to help in emergencies, as in they are in the operating
room. One example is the need of imaging pediatric patients. Small children tend
not to stay still enough for adequate results, and therefore need sedation. Unless properly
planned, pediatric supplies are not commonly found throughout the hospital. Delays in
procuring critical care items could lead to disastrous results.
The special needs of magnetic resonance imaging (MRI) and radiation oncology (e.g.,
proton beam accelerators) present unique challenges to all involved in their use. The most
significant are magnets and invisible forces. Both technologies involve strong forces that
cannot be seen, and catastrophic events can result if mistakes occur. Specialized equipment
is needed, to detect the energy field generated by both types of devices