A trend has recently emerged in the United States whereby surgical procedures are gradually migrating into less complex environments. The demands of cost containment, pressures to limit unnecessary time delays, and desires for increased control have all conspired to promote ambulatory surgicenters, minor procedure centers, and office surgical suites. Concomitant with this shift is a differing attitude toward anesthesia, with an increasing number of procedures using alternatives to general anesthesia such as regional blocks and conscious sedation.

Despite the increased use of local anesthesia and conscious sedation in the office setting, these methods are rarely addressed in the literature. In such a unique environment, the necessity for specific protocols and safeguards is apparent. This article attempts to address such issues, with particular attention to the use of local anesthesia and conscious sedation for endoscopic office procedures.