Professionals

We have a minimum anesthesia charge of one hour and additional charges every 15 minutes. We are in line, or cheaper, than the majority of anesthesia groups or individuals providing in-office anesthesia care. Please give us a call for the most up to date information for your region.

Every provider at Cloud 9 is a board certified Nurse Anesthesiologist. We are all BLS, ACLS, and PALS certified. We all have many years of hospital experience taking care of our most vulnerable and high risk patients.

Please call, text, or email our office manager to set up a time for in-office anesthesia care. We recognize there are many moving pieces to find the right time. We will do our utmost to be flexible and provide a time that will work for you, the patient, and for us.

We will need suction, oxygen, and some basic surgical supplies such as gauze and floss. If you do not have these supplies available in the office, please notify us and we can provide them.

We do not intubate patients unless it is clinically necessary. There are many factors that go into intubating vs not intubating a patient. The guiding principle in airway management is to provide the least invasive care that will provide the safest anesthesia experience for the patient. We have rarely, if ever, found it necessary or clinically beneficial to intubate with the sedation that we provide. We are set up to intubate every patient in an emergency.

Because we do not intubate during the case, our recovery process is much safer and simpler than anything you may have experienced in the hospital setting. We will need a separate chair or space for the patient to recover for 30-40 minutes. They will be placed on monitor and evaluated by the CRNA until they wake up. Once we verify neurological status and airway control, they will be free to go.

The anesthesia member in your office is ACLS trained, and more importantly has many years of independent hospital experience managing emergency situations. It is wonderful to have another ACLS trained provider in the office. We recommend the dentist or surgeon be ACLS certified. We have several recommendations if that is an avenue you are interested in pursuing. DOPL Guidelines currently require 1 ACLS and 2 BLS certified providers during sedation. With our credentials, just one other BLS certified provider is required.

The anesthesia provider is a highly trained member of the care team. They bring the experience necessary to provide safe anesthesia care to your patient. We require one other BLS trained provider in the office for sedation. There is no other extra credentialing required other than to ask questions and be willing to help when asked.

We accept medicaid. If the patient has secondary Medicaid, we must verify that we can bill their primary insurance. Primary insurances we are currently able to bill include: Aetna, Cigna, DMBA, EMI, PEHP, Selecthealth, and United Healthcare. We cannot bill: Medicare, CHIP, Blue Cross Blue Shield, or any other provider not listed above.

We do not bill patients insurance. We require payment the day of service unless we have verified that we can bill Medicaid. Each patient will receive an itemized medical bill that they can submit to their dental and or medical insurance.

We do accept cash. We do not accept personal checks. Care Credit is available upon request.

In order to minimize costs to the patients, minimize interruptions in care, and to be as efficient as possible during the scheduled time, we do ask for help from the front office staff to collect payment. We will provide paperwork and a web based payment portal to accept payment. All that is required is internet access. Please do not hesitate to ask questions if there are concerns.

Although volatile anesthetics have been a mainstay in anesthetics for many decades, there are several reasons why we prefer not to use them.

Anytime you use volatile anesthetics, there is a rare risk of malignant hyperthermia. If this happens in the office setting, the mortality rate is unacceptably high, even if appropriate treatments are immediately available.

Volatile Anesthetics also increase the risk of dysthymic wake-ups, particularly in the pediatric population. Waste gas scavenging systems in the office based system are not sufficiently robust to verify that there will not be cross contamination in the office to the rest of the care team.

We have found that Total Intravenous Anesthesia (TIVA), gives us incredibly profound anesthetic depth while maintaining spontaneous ventilation, significantly decreasing the risk of malignant hyperthermia, decreasing the risk of laryngospasm (particularly in patients with reactive airway disease), and relatively happy wake-ups.

Scheduling multiple patients on the same day for sedation is the most efficient way to utilize anesthesia. We recommend scheduling a regular day each month with Cloud 9 to provide anesthesia. We recommend adding 10-15 minutes more than their scheduled clinical time to allow for patient interviews, transfer to recovery and room clean up per patient. Adult patients may need 15-20 minutes to allow time for wake-up and transfer to a recovery area. There are many ways to increase efficiency during the schedule. Please communicate to us the number of chairs available in your office, potential recovery space, and scheduling needs. We can accommodate and help improve efficiency in many areas.

Pediatric patients typically require 30-40 minutes to wake up after the procedure. The extra sleep really improves the emotional state of the patient when they wake up. Adults require about 5-10 minutes to wake up after the procedure and another 10-20 minutes of recovery prior to going home.

We can schedule out months ahead of time. The sooner you schedule with us, the better we can accommodate needs.

We know emergencies happen. We have been involved with them our whole career at every hour of the day and night as hospital providers. We have worked very hard to keep sufficient staff to be available to help with last minute patients and emergencies. Please contact us to schedule with our office manager. We will do what we can to come after scheduled patients, fit you into the schedule during the day, or come on our day off to help.

We ask that offices collect medical history as part of the intake process to schedule anesthesia. We will contact the patient prior to the surgery if there are medical needs that need to be assessed. The majority of our patients are very healthy with minimal chronic health conditions. Otherwise simple instructions will be given by the office staff to the patients to follow prior to their procedure. If there are any questions, we are available to contact families. We would rather know if there is a question before the surgery to avoid cancellations.