Office Based Anesthesia: Equipment

Regulation of office based anesthesia is delegated to individual states. Lack of federal guidance and with few states having published guidelines, the ASA has published Guidelines for Office-Based Anesthesia first adopted in 1994 but most recently amended in Oct. 2018. Summary points include:

• There should be in each location a reliable source of oxygen adequate for the length of the procedure. There should also be a backup supply. Prior to administering any anesthetic, the anesthesiologist should consider the capabilities, limitations and accessibility of both the primary and backup oxygen sources. Oxygen piped from a central source, meeting applicable codes, is strongly encouraged. The backup system should include the equivalent of at least a full E cylinder.
• There should be in each location an adequate and reliable source of suction. Suction apparatus that meets operating room standards is strongly encouraged.
• In any location in which inhalation anesthetics are administered, there should be an adequate and reliable system for scavenging waste anesthetic gases.
• There should be in each location: (a) a self-inflating hand resuscitator bag capable of administering at least 90 percent oxygen as a means to deliver positive pressure ventilation; (b) adequate anesthesia drugs, supplies and equipment for the intended anesthesia care; and (c) adequate monitoring equipment to allow adherence to the “Standards for Basic Anesthetic Monitoring.” In any location in which inhalation anesthesia is to be administered, there should be an anesthesia machine equivalent in function to that employed in operating rooms and maintained to current operating room standards.
• There should be in each location, sufficient electrical outlets to satisfy anesthesia machine and monitoring equipment requirements, including clearly labeled outlets connected to an emergency power supply. In any anesthetizing location determined by the health care facility to be a “wet location” (e.g., for cystoscopy or arthroscopy or a birthing room in labor and delivery), either isolated electric power or electric circuits with ground fault circuit interrupters should be provided.* 2
• There should be in each location, provision for adequate illumination of the patient, anesthesia machine (when present) and monitoring equipment. In addition, a form of battery-powered illumination other than a laryngoscope should be immediately available.
• There should be in each location, sufficient space to accommodate necessary equipment and personnel and to allow expeditious access to the patient, anesthesia machine (when present) and monitoring equipment.
• There should be immediately available in each location, an emergency cart with a defibrillator, emergency drugs and other equipment adequate to provide cardiopulmonary resuscitation.
• There should be in each location adequate staff trained to support the anesthesiologist. There should be immediately available in each location, a reliable means of two-way communication to request assistance.
• For each location, all applicable building and safety codes and facility standards, where they exist, should be observed.
• Appropriate postanesthesia management should be provided (see Standards for Postanesthesia Care). In addition to the anesthesiologist, adequate numbers of trained staff and appropriate equipment should be available to safely transport the patient to a postanesthesia care unit.