American Society of Anesthesiologists (ASA) 'Wakes Up' to Office-Based Anesthesia (OBA)

Tuesday, October 14, 2008 General News
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CORONA DEL MAR, Calif., Oct. 14 An article in this month'sofficial newsletter of the American Society of Anesthesiologists (ASA) reads:


" ... Office-based anesthesia (OBA) requires a different approach thanthat used in a hospital and an ambulatory surgicenter: not all anesthesiaproviders have the skill, knowledge base or personality to deal with thisenvironment." -- Rebecca Twersky, MD

To this, Homer Simpson would have responded. "Doh."

More than a decade ago, the ASA held quite a different position. Therewere no lectures given at the annual meetings specific to office-basedanesthesia and most definitely no space devoted to OBA in the ASA Newsletter.They were in adamant denial about OBA's very existence.

Why, one might ask?

When asked if he believed there was a difference between anesthesia givenin a surgicenter compared with that given in an office-based setting, in 1995,noted anesthesiologist, Paul F. White PhD, MD, stated, "If it's not done inthe hospital isn't it all ambulatory?"

Staggered by this naive response from White, one of anesthesiology's mostprominent thinkers, Dr. Barry Friedberg was inspired to create the Society forOffice Anesthesiologists (SOFA) in 1996. Independent of Friedberg's effort inCalifornia, Marc Koch, MD, in New York, created the Office Anesthesia Society(OASIS), and Charles Laurito, MD in Chicago, created the Society for OfficeBased Anesthesia (SOBA). The societies, which merged in 1998, were allnon-profit, educational societies created in response to the need to recognizethe difference in the office-based environment. Clearly, OBA was a nascentnational movement. Although the ASA recognized SOBA, they were very slow toappreciate its significance for patient safety.

Another wake-up call came in 2004 when Olivia Goldsmith, author of TheFirst Wives' Club, died as a result of anesthesia while attempting to have achin lift at Lenox Hill hospital in Manhattan. One month later another patientalso died from anesthesia while attempting to have liposuction of her neck.

Cambridge University Press editor, Marc Strauss, asked why theanesthesiologists hadn't read 'the book.' He quickly discovered that there wasno textbook concerning anesthesia for cosmetic surgery. Strauss subsequentlytagged Friedberg for the task of producing such a textbook.

When informed he had been selected first of the then 40,000anesthesiologists in the US, Friedberg asked 'Why me?' He was told that he wasthe only one doing anything different for cosmetic surgery anesthesia andwriting about it.

In April 2007, Cambridge University Press published Friedberg's Anesthesiain Cosmetic Surgery. The book has received positive reviews by the Journal ofPlastic & Reconstructive Surgery, Anesthesia & Analgesia, and DermatologicSurgery.

A Google search for 'office based anesthesia' lists Dr. Friedberg's website as #6 & 10 (non-sponsored) of 254,000 sites. A similar Yahoo search liststhis web site as #9 & 10 (non-sponsored) of 3,820,000 sites. More information

about patient safety in cosmetic surgery anesthesia can be found at


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