Outpatient Surgery Magazine

Salary Survey - January 2020 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 81 of 110

a laryngeal mask airway along with a general anesthetic. Says Dr. Dutton, "It's quite possible that in a few years we'll look at [obese patients] and say, 'We can do this with some sedation and be reason- ably confident the patient will stay saturated on high-flow oxygen.'" One important caveat: High-flow oxygen increases fire risk. Dr. Berkow says these devices address a vital safety issue for ambu- latory facilities: patients with severe sleep apnea who require CPAP. "Being able to better oxygenate them immediately upon extubation may shorten their throughput through the recovery room in an outpa- tient environment," she says. Dr. Losasso believes we don't yet have the tools to definitively deter- mine how big a risk a particular high-BMI patient may be. While you likely have a magic BMI cutoff, "BMI by itself is not necessarily indica- tive of the ability to care for [patients] effectively," says Dr. Losasso, who points to football players whose BMIs are high due to muscle rather than fat. "The question is, what's the magic metric that's more specific than BMI that indicates an airway problem?" Flexible nasopharyngoscopy The ability to assess a patient's airway before surgery continues to develop. "We sometimes forget what almost all the difficult airway algorithms focus on, the first step — assessing your patient and mak- ing an airway plan," says Dr. Berkow. But although pre-op assessment is vital, it's not always performed. "Anecdotally, when you hear about things that don't go well, some- times you'll hear, 'Oh, I have a video laryngoscope, I'll be fine,'" says Dr. Berkow. "But what if your video laryngoscope doesn't succeed? What's your plan B, and are you immediately ready to perform it? Having a backup plan is really important, because if you can't oxy- genate and ventilate your patient, it doesn't matter which device you picked — if it didn't work, you still have a problem if you don't have a 8 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J A N U A R Y 2 0 2 0

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