Guest Editor: Behind the Drape

Anesthesia providers often make everything look easy — perhaps too easy. When staff walk into an OR during a surgical case, it can appear like we’re not doing much at all. But anyone who has ever worked in this field will tell you the same thing: Looks can be very deceiving. In the world of anesthesia, still waters run deep. Anesthesia providers are always laser-focused on our patients. We’re dedicated to preventing and minimizing the pain, nausea and anxiety that are inherent to the trauma of surgery. We’re also obsessively observing and documenting the events of a case because things can change in an instant. We constantly trend, forecast, prepare and anticipate what comes next for our patients because we’re asked to take healthy patients and essentially put them on life support. We are the patients’ vital systems, their cardiac systems, their respiratory systems. I take this responsibility seriously, and I know my peers do, as well.

Of course, most surgical facility leaders fully understand the invaluable role anesthesia plays in the success of any high-volume surgical facility. They saw firsthand how quickly and nimbly we responded during the early months of the pandemic when anesthesia providers were the most sought-after medical professionals. 

We’re now in the midst of yet another industry shift. Though it’s waning, there’s still a backlog of cases from all the delays and postponements of the pandemic. What’s more, there’s an increased demand for routine procedures — such as colonoscopies — being done on sicker patients who largely didn’t venture out due to COVID concerns. Outpatient anesthesia is generally designed for healthier patients with an ASA status between 1 and 3, but now surgery is being performed on sicker and more complicated patients. Procedures performed on these patients can take double the amount of time, all while our performance expectations remain unchanged.

The care of patients with more comorbidities in the outpatient setting is taking place during a staffing crisis where burned out frontline workers are fleeing for higher pay elsewhere. Many facilities are short-staffed and forced to bring on travel staff at higher rates of pay, which breeds resentment among longer-tenured employees. These compounding issues are presenting a challenging environment for all members of the OR team. But the leaders of outpatient facilities have nothing to fear — at least from their anesthesia departments. We’re hard-wired to rise to any challenge, and we often find some surprising ways to solve problems. Here’s just one small example: Facing a supply shortage of end-tidal tubing, we came up with a creative solution that involved using IV tubing and cannulas to monitor CO2. The tubing was a different diameter, but it still got the job done until our supply levels returned to normal.

In this Outpatient Surgery Magazine special issue, you’ll read about other creative workarounds and proven best practices from my peers in the anesthesia. You’ll also get practical tips on performing regional bocks, handling challenging airways, preventing PONV and training staff on a rare but potentially fatal malignant hyperthermia event.

You’ll even hear from an anesthesiologist who went to Ukraine to share his medical skills with a country that was desperately in need of such expertise. It’s my honor to serve as the guest editor of this issue and to contribute to one of the stories inside. I hope readers come away with an idea of the passion and unrelenting vigilance anesthesia providers bring to the table for every case, and see that no matter how calm, cool and collected we appear on the surface, we’re always working tirelessly behind the drape. OSM