Dr. Desai ([email protected]) is the president of the Society for Ambulatory Anesthesia and managing partner of Nova Anesthesia Professionals in Villanova, Pa. She's also vice chair of the board of the AAAHC and an active member of the ambulatory surgical committee of the American Society of Anesthesiologists.

Patients are sicker and heavier. How sick is too sick and how heavy is too heavy?
We're successfully caring for high-acuity patients because our skill sets have evolved dramatically over the past 10 years. Anesthesia providers ultimately decide which patients enter the OR. That's often looked upon favorably by nursing and patient safety advocates, but sometimes not so favorably by those who want patients captured in the revenue stream. Balancing patient safety with convenience is imperative for all locations of surgical care.

What challenges do anesthesia providers face as more complex procedures move to same-day surgical facilities?
The better our abilities get, the more we're going to push the envelope of shifting patients to the outpatient arena. We're honing our post-op pain management capabilities and our discharge skills are getting better. When we put all that together, more challenging procedures will migrate safely to ambulatory facilities.

Patient-centered care and healthcare transparency are emphasized now more than ever. How do those factors impact anesthesia care?
It's been decided politically and socially that health care will become consumer- oriented. That means outcome data need to be captured and advertised. Transparency is about outcomes as much as it is about cost. When you're good, you need relevancy and numbers to back it up. Patient selection is a large part of good patient outcomes. Appropriate patient selection sets up quality outcomes, and you need to capture those results.

What innovations are improving the way anesthesia is delivered?
Multimodal pain management is the simplest to implement and the hardest to monitor. It's not something we're getting paid more for, so some centers opt for easier pain techniques. Ultrasound lets providers administer more complex regional blocks and video laryngoscopes have added a much-needed degree of safety in the outpatient setting.

What are your thoughts on Sedasys?
It's shown to be useful in particular settings, but it still has difficulties managing low oxygen saturation levels, declining end-tidal CO₂ measures and patients who lose consciousness. There are a lot of questions yet to be answered, especially when neither safety or efficiency are significantly enhanced.

What excites you about the future of anesthesia?
I'm excited to be part of a specialty that has actually pursued and achieved safer outcomes over the last 20 years. We've always been invested in safe patient care, and that appeals to me.