Surgeons perform cutting-edge care and nurses are the heart of health care, but it’s anesthesia providers who have their fingers on the pulse of same-day surgical care. Their abilities to effectively prevent and manage pain, prevent PONV, titrate sedation levels and secure the most difficult of airways determine how quickly and safely patients move through your facility.

Anesthesiologists are increasingly more involved throughout the entire episode of care in order to optimize patients for surgery, see them safely through procedures and prepare them for excellent outcomes. Same-day surgery accounts for about 70% of all elective procedures performed in the United States, and with total joints, thyroidectomies and hysterectomies joining a growing list of complex procedures that no longer have to be performed in inpatient ORs, anesthesia’s role in your surgical team’s ability to perform effective and efficient care has never been more important.

• Giving the green light. You wouldn’t be able to perform complex surgeries in your ORs without the approval and skill of anesthesiologists. Their abilities to assess individual patients’ comorbid conditions in the context of scheduled procedures and planned anesthesia techniques are critical to identifying appropriate candidates for same-day surgery. Providers can turn high-risk candidates into lower-risk patients by addressing triggers for complications — excess weight, cardiopulmonary disease and sleep apnea, to name a few — long before the day of surgery.

Older patients with acute conditions, including obesity and obstructive sleep apnea, have increased the importance of identifying proper candidates for same-day surgery. An anesthesiologist’s clinical insights and trusted opinion ensure patient safety is always prioritized over growing case volumes and increasing surgical revenues.

• Enhanced pain management. Anesthesiolo-gists are trained to identify patients predisposed to experiencing significant discomfort after surgery and are taking steps to manage post-op pain with regional anesthesia and oral analgesics, and fewer opioids in light of the national opioid crisis, which has created an urgent need to prescribe alternative therapies to recovering patients.

To manage significant post-op pain with fewer opioids, providers are increasingly administering regional anesthesia and instructing patients to take acetaminophen and non-steroidal anti-inflammatories (NSAIDs) or cyclooxygenase (COX-2) specific inhibitors — a pairing that provides post-op pain relief better than the use of either drug alone — as part of a balanced, round-the-clock analgesia regimen. Giving patients Tylenol (1,000 mg) and meloxicam (15 mg) as a primary treatment and oxycodone as needed for breakthrough pain is at least as effective as opioids alone and avoids opioid-related side effects that can delay recovery and discharge.

• Proactive PONV prevention. Administering IV dexamethasone 8 mg after anesthesia induction and a 5 hydroxytryptamine-3 (5HT3) antagonist, such as IV ondansetron 4 mg, at the end of procedures should be used at the minimum to prevent PONV in most patients. Transdermal scopolamine or IV haloperidol during surgery might be needed to settle the stomachs of high-risk patients. Long-acting 5HT3 antagonists such as palonosetron can prevent post-discharge nausea and vomiting, a key concern among providers in outpatient surgical facilities.
• Expertise in regional blocks. Anesthesiologists advance pain management by placing local and regional blocks that provide effective pain relief after major procedures. Single-shot adductor canal and popliteal-sciatic nerve blocks are helping to move knee replacements and major foot and ankle procedures to outpatient facilities. Interscalene blocks are being used to increase patient comfort after notoriously painfully shoulder surgeries.

The erector spinae plane block, a type of interfascial plane block, is an exciting development in regional anesthesia that could replace transverse abdominis plane (TAP) blocks and quadratus lumborum (QL) blocks for outpatient procedures performed at the thorax and abdomen, including breast surgeries and hysterectomies.