Over the last 20 years there has been an impressive shift in numbers from inpatient to outpatient surgery. Upon questioning, most people would prefer to enjoy the comforts of their own home and not be admitted to the hospital postoperatively. This is only one of the reasons ambulatory surgery has attained such popularity. Newer less invasive procedures, shorter acting medications, and computer-assisted technology have also helped propel an “in and out” the same day procedural philosophy. Approximately 80% of all surgeries are currently performed in outpatient facilities, either connected to hospitals or in separate surgical centers (1). More recently there has been a rising trend for surgery to be performed within the physician’s office (see Figure 4.1).

Office-based surgery can offer the convenience of having procedures performed in a more comfortable setting with an expedient return home (1). To entice and titillate the consumer, doctors’ offices have been furnished with modern art, classical antiques, Zen-like minimalist Feng Shui design, scented candles, water fountains, soothing music, cashmere blankets, and even wheat germ smoothies of assorted green and white anti-oxidant teas—just a few of those “spalike touches” that appeal to the senses.

The American Society of Anesthesiologists (ASA) reports that in 2005 an estimated 10 million procedures were performed in physicians’ offices, twice the number of office-based procedures performed in 1995 (1). In addition to the aesthetics described in the preceding text, office-based surgery provides flexibility and ease of scheduling, as well as increased efficiency compared with hospital-based surgery.

Because numerous types of surgical procedures are being performed, a wide range of anesthetic techniques are also available. The continuum of these ranges from light sedation or anxiolysis to general anesthesia. Providing services in an office-based setting is a prime opportunity for anesthesiologists to practice in an environment slightly different than the traditional hospital setting. The office setting presents its own unique challenges. It emphasizes the importance of the anesthesia personnel’s role as true perioperative physicians, those who are present throughout the ‘pre-, intra-, and postoperative period’.

In addition, it is also an environment that requires a more social interaction in order to appease, support, and nurture the patient. It is a time for anesthesiologists to showcase their personalities to enhance the patient’s feeling of importance and self esteem while still delivering safe anesthetic care.

The office-based setting is discreet, nurturing, and hassle free, so why is it often termed the “Wild, wild west” of health care?