American Society of Anesthesiologists (ASA) 'wakes up' to office-based anesthesia (OBA)

Corona del Mar, CA
October 14, 2008

An article in this month’s official newsletter of the American Society of Anesthesiologists (ASA) reads:

“…office-based anesthesia (OBA) requires a different approach than that used in a hospital and an ambulatory surgicenter: not all anesthesia providers have the skill, knowledge base or personality to deal with this environment." – Rebecca Twersky, MD

To this, Homer Simpson would have responded. “Doh.”

More than a decade ago, the ASA held quite a different position. There were no lectures given at the annual meetings specific to office-based anesthesia 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 given in 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 in the hospital isn’t it all ambulatory?”

Staggered by this naïve response from White, one of anesthesiology’s most prominent thinkers, Dr. Barry Friedberg was inspired to create the Society for Office Anesthesiologists (SOFA) in 1996. Independent of Friedberg’s effort in California, Marc Koch, MD, in New York, created the Office Anesthesia Society (OASIS), and Charles Laurito, MD in Chicago, created the Society for Office Based Anesthesia (SOBA). The societies, which merged in 1998, were all non-profit, educational societies created in response to the need to recognize the difference in the office-based environment. Clearly, OBA was a nascent national movement. Although the ASA recognized SOBA, they were very slow to appreciate its significance for patient safety.

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

Cambridge University Press editor, Marc Strauss, asked why the anesthesiologists hadn’t read ‘the book.’ He quickly discovered that there was no textbook concerning anesthesia for cosmetic surgery. Strauss subsequently tagged Friedberg for the task of producing such a textbook.

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

In April 2007, Cambridge University Press published Friedberg’s Anesthesia in Cosmetic Surgery. The book has received positive reviews by the Journal of Plastic & Reconstructive Surgery, Anesthesia & Analgesia, and Dermatologic Surgery.
A Google search for ‘office based anesthesia’ lists Dr. Friedberg’s web site as #6 & 10 (non-sponsored) of 254,000 sites. A similar Yahoo search lists this 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 www.drfriedberg.com.