RMV->)Better Postop Pain Control
Re: "Blocking Out Postop Pain" (January, page 28). This excellent article accurately describes new approaches to regional anesthesia/analgesia practice. I am doing the type of outpatient regional anesthesia described in the article (limited to orthopedic cases because our ASC is dedicated to orthopedic surgery). I was a guest at the Duke outpatient facility in September, and am familiar with what they do there. I have patterned my practice on similar procedures, with exceptional acceptance by the surgeons and patients. Hopefully, more anesthesiologists will utilize these techniques.

Charles A. Kottmeier, MD
Medical Director and Anesthesiologist
Orthopaedic Surgery Center of Clearwater
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Preop Patient Assessment

Preop Patient Assessment
Re: "Preoperative Anesthesia Testing Gets Smarter" (December, page 48). What role does the supervising anesthesiologist play in this case-by-case screening of patients? In our ASC, we have a PAT nurse who performs phone assessment with the patient. Based on this interview and a preop testing requirements laundry list, the PAT nurse assures that the appropriate testing is ordered and performed. Once the testing results have been received, the anesthesiologist then reviews the chart. Does your anesthesiologist review every patient's chart before testing is ordered? If not, what are the logistics of your screening process? I am very interested in improving our PAT process.

Holly Nelson RN
Nurse Manager
Executive Woods ASC
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Dr. Alan Marco replies:
At our facility, we use specifically trained nurses to do the bulk of the preoperative evaluations (history and basic exam). An attending anesthesiologist who covers the Preoperative Evaluation Center is available for consultation. We let the surgeons order whatever tests they feel are necessary for the surgery - especially if they are done at an outside facility.