Outpatient Surgery Magazine - Subscribers

COVID-19 Crisis - Outpatient Surgery Magazine - April 2020

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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office-based procedure, according to Mani Zadeh, MD, FACS, a Los Angeles-based ENT surgeon. Dr. Zadeh estimates that at least half of the balloon sinuplasties performed nationally now take place in doc- tors' offices. "It's a procedure for which general anesthesia is not required," says Dr. Zadeh. "We can use local or topical anesthetics that greatly minimize any discomfort." The procedure treats sinusitis by widening the sinus drainage cav- ity to six millimeters. A deflated or compressed balloon is inserted into the narrow portion of the patient's sinus. When inflated, it essentially squeezes and crushes the soft tissue and creates microfractures in the nearby bone to widen the cavity. Performing the procedure in the office has multiple benefits for patients. First, they don't have to undergo general anesthesia. Because of that, the recovery is quick. They're awake for the entirely of the operation — the worst post-op symptom is often the feeling of having a stuffy nose — so they can drive themselves home. Patients also avoid the time-consuming admissions process at a hospital or surgery center, and they can skip the pre-op blood test that's part of the evalu- ation to determine if they're a safe candidate for general anesthesia. The local anesthetics used for balloon sinuplasties have improved in the last two years, after the operation had begun to move to pro- cedure room, which makes it even more suitable for the office set- ting. Dr. Zadeh says he used to use common topical sprays or local injectable anesthetics. Now, he partners with compounding pharma- cies to increase the concentration of tetracaine, which is commonly used at a lower strength in eye procedures, to 6% in the local anes- thetic he uses, making it effective in sinus surgeries. Further, the higher-dose tetracaine used to come in a liquid that tended to drip to the back of the throat. Now it's delivered in a paste form that makes its coverage more precise and effective. "These two simple improve- 6 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A P R I L 2 0 2 0

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