J U LY 2 0 1 5 O U T P A T I E N TS U R G E R Y. N E T 5
J u l y 2 0 1 5 | w w w . o u t p a t i e n t s u r g e r y . n e t
A m b u l a t o r y A n e s t h e s i a
C O N T E N T S
6 Which Drug is Better
For Post-op Pain Control?
Bupivacaine, at a price of about $2.80 per
shot, or the liposomal bupivacaine formula-
tion trade-named Exparel, at about $285
per vial? What we found may surprise you.
Dan O'Connor | Editor-in-Chief
17 A New Way to
Manage Post-op Pain
The Perioperative Surgical Home model
is revolutionizing patient care with preset
clinical pathways for specific cases.
Zeev Kain, MD, MBA
24 6 Things MH
Experts Want You to Know
The MHAUS hotline medical director
answers your most pressing questions.
Ron Litman, DO
30 4 Keys to a Sound
Patient Warming Strategy
Diminish the chilling impact of redistribution
hypothermia.
Jim Burger | Associate Editor
38 What Difficult Veins?
Imaging technology all but guarantees
first-stick success when starting IVs.
Daniel Cook | Executive Editor
43 The Next-Generation
Anesthesia Machines
Technology updates make anesthesia deliv-
ery safer for patients and easier for
providers.
Michael A. Olympio, MD
51 5 Keys to Managing Sleep Apnea
Pre-op assessments and taking the proper
precautions on the day of surgery will help
keep these high-risk patients safe.
Reginald F. Baugh, MD
57 How We Prevent PONV
For at-risk patients,
targeted interventions spell relief.
Christopher A. Smith, CRNA, DNP
62 Does Your Anesthesia
Service Make the Grade?
Look for these qualities
at the head of the OR table.
Carrie L. Frederick, MD
67 The Gatekeepers of
Ambulatory Surgery
Q&A with Meena S. Desai, MD, an anesthe-
sia society leader and patient safety advo-
cate.
43
M a n a g e r ' s G u i d e t o
To Our Readers
It sounds like a great idea. Encapsulate bupivacaine in tiny bubbles made out of the same material
as a cell membrane, and inject it into the muscles and soft tissues around the surgical wound. Like
soap bubbles in a dishpan, these bubbles would burst slowly and predictably, releasing the pain-numbing medication over 72 hours for up to 3 days
of pain control. That's the promise of Exparel (liposomal bupivacaine) from Pacira Pharmaceuticals. Turn the page to find out if Exparel, at $285 a bot-
tle, is any better than $2.80 bupivacaine. We hope this and the other articles in the Manager's Guide to Ambulatory Anesthesia help you and your
anesthesia providers optimize case outcomes and enhance the patient experience from pre-op to the PACU.
Cover design by Ethan Anderson | Photo by Lynda Dowman-Simon, RN