Mobile Anesthesia Services for Plastic Surgery Offices: What Surgeons Should Look For

Office-based practices may engage an outside anesthesia clinician or team to provide on-site care. A mobile anesthesiologist is a physician who provides anesthesia care at the procedural facility; the practice should separately verify the facility's accreditation status and the legal requirements that apply to it. What follows is the short list of items that should be settled in writing before the first case, each drawn from an existing ASA standard rather than from preference.

What the office case actually involves

Office-based aesthetic surgery — liposuction, facelift, breast augmentation, rhinoplasty and combined cases — is often performed under total intravenous anesthesia or deep sedation with local anesthesia, occasionally with regional blocks. That is the depth at which airway support may be required, and at which a patient who has fasted as instructed may still be at risk of aspiration. The standards below apply across that range.

Which standards apply in an office

The ASA's Statement on Office-Based Anesthesia recommends that an office setting follow the standards that govern anesthesia care elsewhere — the Basic Standards for Preanesthesia Care, the Standards for Basic Anesthetic Monitoring and the Standards for Postanesthesia Care — and that facilities keep written emergency protocols, appropriate emergency equipment and drugs, and a written protocol for the safe and timely transfer of patients to a prespecified alternate care facility.¹ Discharge from anesthesia care is a physician responsibility and should be documented in the medical record.¹

Monitoring requirements

The ASA Standards for Basic Anesthetic Monitoring apply to general anesthesia, regional anesthesia and monitored anesthesia care, subject to the exceptions described in the document, and require continual evaluation of oxygenation, ventilation, circulation and temperature.² Coverage documentation should state which of these elements the anesthesia provider supplies, which the facility supplies, and who is accountable for each.

Managing the sedation continuum

Sedation is a continuum, and patients can pass into a deeper level than intended. The ASA states that practitioners should be able to rescue patients from a level deeper than the one planned, and that it is not appropriate to continue a procedure at an unintended level of sedation.³ Qualifications, monitoring practice, rescue capability and emergency arrangements are items a practice should examine directly rather than assume.

Patient selection and preoperative evaluation

Office-based suitability depends on individualized assessment rather than procedure type alone. A thorough preanesthesia evaluation — history, airway assessment, comorbidities such as obstructive sleep apnea — should guide that decision.⁴ The medication list should be read for GLP-1 receptor agonists, which delay gastric emptying and are addressed by their own perioperative guidance.⁵

Technique suited to aesthetic surgery

Depending on the procedure and the patient, the anesthesia plan may include total intravenous anesthesia (TIVA), regional nerve blocks or other techniques. Potential benefits and limitations differ by technique, and neither guarantees a smooth emergence, freedom from nausea or same-day discharge. See our articles on TIVA and regional anesthesia.

What to obtain in writing before the first case

• Current license and board certification, and the procedures and patient populations the provider is credentialed to anesthetize.
• Which monitoring equipment the provider brings and which the facility supplies.
• The written emergency protocol, the drugs and equipment on site, and the named alternate care facility for transfer.
• Who performs the preanesthesia evaluation, and who makes and documents the discharge decision.
• The plan for a patient who reaches a deeper level of sedation than intended.
• How each case is documented for accreditation and billing.

Dr. Seitz provides anesthesia for office-based procedures.

Sources

1. American Society of Anesthesiologists. Statement on Office-Based Anesthesia. Original approval October 13, 1999; last amended October 23, 2024.
2. American Society of Anesthesiologists. Standards for Basic Anesthetic Monitoring. Original approval October 21, 1986; last amended October 15, 2025.
3. American Society of Anesthesiologists. Statement on Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia. Original approval October 13, 1999; last amended October 23, 2024.
4. American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Practice advisory for preanesthesia evaluation: an updated report. Anesthesiology. 2012;116(3):522–538.
5. Kindel TL, Wang AY, Wadhwa A, et al. Multisociety Clinical Practice Guidance for the Safe Use of Glucagon-like Peptide-1 Receptor Agonists in the Perioperative Period. Clin Gastroenterol Hepatol. Published online October 29, 2024.