Non-Operating Room Anesthesia in the Ambulatory Setting

Fresh off a restful beach vacation, you arrive at Advanced Surgery and Endoscopy Center, a freestanding multispecialty site newly staffed by your group. While enjoying your breakfast, you are emergently called to the GI suite to attend to George, an elderly gentleman having a difficult resection of a proximal colon mass under sedation provided by the GI physician and a nurse. George is moderately obese (BMI 33) with hypertension, COPD on inhaled bronchodilator therapy and obstructive sleep apnea treated with nighttime CPAP. As you are quickly assessing him, the frantic nurse tells you that George was really anxious and wanted to “be completely knocked out.” Midway through the procedure, the GI physician was struggling, and George was moving despite loud snoring. The nurse had given a total of midazolam 8 mg I.V. and fentanyl 100 mcg I.V. in divided doses, at which point George began to retch and his breathing...