Ambulatory, office-based anesthesia (OBA) has experienced an exponential growth in the last decade, and is popular among patients and health care providers alike. About 17% to 24% of all elective ambulatory procedures in the United States are currently being performed in an office-based setting. Special considerations must be made when comparing OBA to a hospital setting, particularly with respect to facility and environment, administration, and accreditation. Increasing regulation will ensure that patient safety remains the primary focus. In the meantime, the anesthesia provider must take adequate steps to ensure that the quality of care in OBA is comparable to that in a hospital.