miles from the nearest hospital, I'd think harder about it," admits Dr.
Jacobs.
Dr. Jacobs recalls another borderline patient, this one a 63-year-old
male, 6-foot-1 and 180 pounds., scheduled for microdirect laryn-
goscopy with excision of a vocal cord mass. His history included
hypertension, sleep apnea and CPAP, and severe aortic stenosis status
post valve replacement in 2011. A stress test the month of surgery
showed no ischemia, normal wall motion and a well-functioning pros-
thetic valve. Dr. Jacobs deemed this patient suitable for surgery. First,
a clearance note from the cardiologist said his cardiac status was sta-
ble. And while sleep apnea is a major concern with an airway proce-
dure, Dr. Jacobs says this patient's was mild to moderate at most,
after discussing the patient with the surgeon. Plus, the surgical proce-
dure is usually rather quick and the surgeon said the mass was small.
One concern: On the day of admission, the patient admitted to a 50-
year smoking history (he quit in 2013). The case went well. The
patient was an easy mask ventilation, but was a slightly difficult intu-
bation. "The anesthetic was otherwise uneventful, as was his recov-
ery-room stay," says Dr. Jacobs.
Changing times
Outpatient surgery used to be cataracts and carpal tunnels: short, sim-
ple, safe surgeries. Advances in regional anesthesia, surgical technique
and long-lasting post-op pain control have opened the floodgates to
more patients undergoing more painful, invasive surgeries, like total
joints and lap choles, in the morning and still getting home in time for
dinner.
"It's not uncommon for ASA 3 patients to undergo procedures last-
ing more than an hour," says anesthesiologist Sean Daley, MD, of
Sarasota (Fla.) Anesthesiologists. "As more and more surgeons want
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