On Point: Leading From the Head of the Table

During the peak of the coronavirus outbreak, anesthesiologists used their exceptional skills to provide life-saving care under unimaginable pressure. That didn't surprise me one bit.

The COVID-19 crisis showed anesthesiologists are far more than just experts in anesthesia care. They are intensivists, leaders in times of change and the source of much medical innovation. They are the collaborators who help create the policies and guidelines that drive team-based care. Most recently, the American Society of Anesthesiologists (ASA) collaborated with the Association of periOperative Registered Nurses (AORN), the American College of Surgeons (ACS) and the American Hospital Association (AHA) in developing a practical roadmap that guides facilities as they resume elective surgeries.

Anesthesia professionals are doers, leaders and master collaborators. They're often the medical directors of ASCs. They're instrumental in creating policies that ensure safe patient care. They use their expertise to guide accrediting organizations and CMS in developing comprehensive policies and payment guidelines for advanced ambulatory surgical care.

Between more expansive patient and staff safety protocols that will be a cornerstone of post-COVID care and new technologies that will bring an influx of minimally invasive procedures to HOPDs and ASCs throughout the country, the future promises to be an exciting time for anesthesia.

CMS is providing funding and authorizing payments for cardiac catheterization-related procedures performed on an outpatient basis and increasing numbers of total joint replacements are being done in surgery centers. In order to achieve successful outcomes for these cases, superior anesthesia is a must. Here are just a few ways anesthesia professionals are helping to advance outpatient care.

• Targeted pain control. Providing opioid-sparing analgesia for outpatient surgeries, particularly notoriously painful procedures such as total knees and hips, continues to be a top concern for anesthesia providers. If opioid-sparing total joint surgeries are to succeed, the right pain management protocols must be in place. Round-the-clock usage of acetaminophen and NSAIDs must be the standard of care.

Anesthesiologists have been employing opioid-sparing approaches to mitigate the side effects of narcotics and get patients up and moving quickly long before it became as fashionable as it is today.

Single-shot regional blocks and continuous nerve blocks will play pivotal roles in limiting the need for highly addictive painkillers in the intra- and post-op phases of care as more complex procedures move to outpatient ORs. Advances in block techniques and technologies let anesthesia providers select the regional anesthetic that's most appropriate for the procedure.

Anesthesia providers lead regional block programs, but placing blocks requires an integrated team-based approach for maximum effectiveness. Your entire staff needs to understand exactly when a block will wear off, what the plan is when it does and the multimodal cocktail that will be most effective in controlling pain for individual patients.

• New tools to try. From advancements in vital signs monitoring to better and more portable ultrasound-guided devices for regional anesthesia, there's no shortage of cutting-edge technology in which your facility can invest. Most anesthesiologists are techies by nature who often don't hesitate to embrace new technologies. However, you have to be careful that your providers are using tools because they improve patient care, not just because they're new. Do the research and study proven clinical benefits to determine whether the latest vital signs monitors, laryngoscopes or ultrasound machines are truly cost-effective options.
• Managing difficult airways. Advancements in video laryngoscopes, video bronchoscopes and supraglottic airways have made it easier to handle difficult airways, one of the most challenging aspects of anesthesia care. Airway management is built upon the expertise of anesthesiologists, who have experience in and knowledge of securing even the most difficult airways. Adding the latest devices to their toolkits will complement their clinical expertise and ensure patient safety remains a top priority.

There may be minor surgery, but there will never be minor anesthesia.

As we inch back to pre-pandemic case volumes, anesthesiologists will help move surgical care forward. They have a holistic breadth of knowledge to ensure facilities achieve financial success, as well as the and the practical skills and science-based knowledge needed to achieve positive outcomes.

There may be minor surgery, but there will never be minor anesthesia. As anesthesia professionals' roles continue to expand, their commitment to patient safety will remain the foundation that guides every advancing step. OSM