SAMBA's Clinical Practice Guidelines

2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway
Jeffrey L. Apfelbaum MD, et. al.

SAMBA supports the utilization of the ASA difficult airway algorithm in airway management when the situation arises in ambulatory sites. Updates to the algorithm in 2022 include recommendations from international anesthesiologists, updated equipment for airway management, suggestions for extubating difficult airway patients, and new infographics and algorithms.

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The Use Of Pectoralis Blocks In Breast Surgery: A Practice Advisory From The Society For Ambulatory Anesthesia (SAMBA)
Alberto Ardon MD, et. al.

More institutions are utilizing pectoralis blocks for breast surgery. This could lead to a reduction in PACU opioid consumption and decrease postoperative pain scores when compared to systemic analgesics. PECs blocks seem to be equal in comparison to a single-shot paravertebral injection regarding postoperative opioid requirements and time to rescue analgesia. Although further investigation is necessary, these blocks could be an extremely useful tool in the ambulatory setting.

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SAMBA, SASM and SOCCA Collaborative Guidelines for Postoperative Management of Patients with Obstructive Sleep Apnea
Mandeep Singh, MBBS, MD, MSc, FRCPC, et. al.

SAMBA, SASM and SOCCA have collaborated to investigate and provide guidelines for post-operative management in patients with OSA. Pre-operative screening and intraoperative management guidelines exist, and this project will complement and complete evidence-based perioperative recommendations for patients with OSA. Stay tuned for the publication…

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Consensus Guidelines for Managing Postoperative Nausea and Vomiting (Updated in 2014)
Tong J. Gan, MD, et. al. 

A systematic review of the literature was performed through 2019 to update the guidelines for managing PONV. One major update is the recommendation to administer multimodal prophylactic medications in patients with just 1 or 2 PONV risk factors. Combination therapy should be used for prophylaxis, and medication from a different class than was given prophylactically should be administered in need of rescue.

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Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery
Girish P. Joshi, MB, BS, MD, FFARCSI, et. al.

A systematic review of the literature was performed to establish a consensus on glucose management in the ambulatory setting. It was found that evidence was lacking for strong perioperative glucose control recommendations. Based on general principles, SAMBA recommends a target glucose <180mg/dL in well-controlled diabetics and to maintain glucose around baseline in poorly controlled diabetics. The preferred route and medication are fast-acting subcutaneous insulin administration for its favorable pharmacokinetics, cost-effectiveness, and duration of action.

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Consensus Statement on Selection of Patients With Obstructive Sleep Apnea Undergoing Ambulatory Surgery
Girish P. Joshi, MB, BS, MD, FFARCSI, et. al.

Patients with OSA can pose a challenge in the ambulatory setting with their increased risk of perioperative complications. SAMBA conducted a systematic review to develop practice guidelines as a tool for ambulatory centers. Patients with known and treated OSA, as well as those with presumed OSA can be considered for ambulatory surgery if they are medically optimized and able to use CPAP in PACU. Multimodal pain management is recommended to decrease perioperative opioid use and subsequent potential respiratory complications.

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Pain Management for Ambulatory Arthroscopic Anterior Cruciate Ligament Reconstruction: Evidence-Based Recommendations From the Society for Ambulatory Anesthesia
Faraj W. Abdallah, MD, et. al.

Anterior cruciate ligament reconstruction arthroscopic surgery patients often have moderate pain postoperatively. Multiple regional analgesia techniques have been used to decrease pain including femoral nerve or adductor canal blocks or local instillation by surgeons, and there is evidence to support each. Analyzing systematic reviews and endorsed by SAMBA, this paper found that local instillation was the best technique overall when combined with multimodal analgesia.

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