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Non-Operating Room Anesthesia E-Book

Non-Operating Room Anesthesia E-Book

Mark S. Weiss | Lee A Fleisher

(2014)

Additional Information

Book Details

Abstract

The demand for anesthesiologists outside of the operating room continues to grow as the number of minimally invasive procedures proliferates and the complexity of diagnostic procedures undertaken outside of the OR increase. Non-Operating Room Anesthesia is an easy-to-access, highly visual reference that facilitates an in-depth understanding of NORA procedures and protocols needed to minimize risk and complications and to maximize growth opportunities.

  • Effectively assess and manage risks and differences in procedures through in-depth discussions addressing the unique challenges and issues associated with non-traditional settings.
  • Review the most recent knowledge with updated coverage of the use of the electrophysiology lab (EPL) and cardiac catheterization laboratory (CCL) in the care of the critically ill patient; patient assessment; and anesthetic considerations.
  • Prepare for varying anesthetic conditions in non-OR settings with in-depth discussions on communication, management, and laboratory preparation for anticipated concerns or complications.
  • Glean all essential, up-to-date, need-to-know information about NORA with coverage that surpasses the depth and scope of review articles and other references.
  • Focus on the practical guidance you need thanks to a user-friendly color-coded format, key points boxes, drug descriptions, checklist boxes (for monitors, equipment, and drugs), and over 400 color photos that help you visualize each procedure and setting.

  • Table of Contents

    Section Title Page Action Price
    Front Cover Cover
    IFC IFC
    Non–Operating Room Anesthesia i
    Copyright ii
    Dedication iii
    About the Authors v
    Contributors vii
    Foreword x
    Preface xi
    Contents xii
    Downloadable File Contents xv
    1 - Engineering Excellence in Non–Operating Room Anesthesia Care 2
    Achieving Excellence in Health Care 2
    Proactive Versus Reactive Approach to Problems 3
    Proactive Approaches: Anticipating Problems 3
    Reactive Approaches: What Happens When Something Goes Wrong 5
    Moving from “Good to Great”: Organizational Approaches to Excellence 6
    Conclusion 6
    References 7
    2 - Designing Safety and Engineering Standards for the Non–Operating Room Anesthesia Procedure Site 8
    Initial Planning 8
    Ergonomics 9
    Movement 10
    Tasks 10
    Communication 10
    Lighting 10
    Noise Control 10
    Temperature Control 10
    Power Management 11
    Ventilation 12
    Materials Management 12
    Individual Non–Operating Room Anesthesia Sites 12
    Conclusion 15
    References 17
    3 - Room Setup, Critical Supplies, and Medications 18
    Room Setup 18
    Critical Supplies 24
    Safety Issues in Non–Operating Room Anesthesia Locations 24
    Medications 26
    Allergic Reactions 28
    Benzocaine Spray and Methemoglobinemia 28
    Malignant Hyperthermia 29
    Conclusion 29
    References 29
    4 - The Role of the Non–Operating Room Anesthesiologist 30
    Oversight of Non–Operating Room Anesthesia 30
    Levels of Sedation and Anesthesia 31
    Organizing Safe Practice 32
    Equipment 33
    Personnel 33
    Conclusion 34
    References 34
    5 - Continuous Quality Improvement for Non–Operating Room Anesthesia Locations 36
    Quality 36
    Selecting Indicators 36
    Validity of Continuous Quality Improvement Indicators in Anesthesiology 37
    Methods to Improve Quality of Care: Quality Improvement Model Descriptions 38
    Critical Incidents 38
    Sentinel Events 38
    Root Cause Analysis 39
    Human Factors Analysis 40
    Quality and Safety Improvement Efforts Outside the Operating Room 41
    Conclusion 42
    References 42
    6 - Critical Monitoring Issues for Non–Operating Room Anesthesia 43
    Basic Monitors 43
    Temperature 45
    Advanced Monitors 46
    Site-Specific Monitoring Considerations 47
    Conclusion 48
    References 48
    7 - Intravenous Anesthesia and Sedation Outside the Operating Room 50
    Sedation, Sedation and Analgesia, and Anesthesia 51
    Drugs Used for Sedation and Anesthesia 52
    Monitoring During Total Intravenous Anesthesia and Analgesia 56
    Side Effects and Complications 56
    Recovery and Discharge 57
    Total Intravenous Anesthesia for Specific Patients 58
    Conclusion 59
    References 59
    8 - Practice Procedure 62
    Patient Selection 62
    Pitfalls of Non–Operating Room Anesthesia 63
    Risks and Safety of Non–Operating Room Anesthesia 65
    The Future of Non–Operating Room Anesthesia 67
    References 68
    9 - Preoperative Evaluations 70
    Preoperative Assessment 70
    Coexisting Diseases 73
    Preoperative Testing 78
    Perioperative Medications 78
    Fasting Guidelines 80
    Conclusion 80
    References 80
    10 - Anesthesia in the Catheterization Laboratory: Valves and Devices 82
    Hemodynamic Monitoring 82
    Transcatheter Aortic Valve Replacement 83
    Transcatheter Aortic Valve Replacement Procedural Complications 85
    Transapical Closure of Mitral Prosthesis Paravalular Regurgitation 87
    Left Atrial Appendage Closure Device 88
    Mitral Valve Edge-to-Edge Clip Repair 88
    Conclusion 88
    References 90
    11 - Anesthesia for Electrophysiology Procedures 91
    Role of the Anesthesiologist in the Electrophysiology Laboratory 91
    Considerations in the Electrophysiology Laboratory 92
    The Physiology of Cardiac Arrhythmias 100
    Catheter-Based Ablations 102
    Device Implantation 107
    Lead Extractions 108
    Noninvasive Programmed Stimulation 109
    Postoperative Care and Pain Management 109
    Conclusion 110
    References 110
    12 - Anesthesia for Cardioversion 113
    Preoperative Assessment 113
    Intraoperative Management 114
    Postoperative Course 115
    Conclusion 115
    References 115
    13 - High-Frequency Ventilation for Respiratory Immobilization 117
    Uses of High-Frequency Ventilation for Respiratory Immobilization 117
    Types of Ventilators 118
    Physics of High-Frequency Jet Ventilation 121
    Entrainment 121
    Carbon Dioxide Elimination 122
    Breath Stacking 122
    Monitoring of High-Frequency Jet Ventilation 123
    Humidification of Inspired Gas 124
    Hemodynamic Effects of High-Frequency Jet Ventilation 124
    The Physiology of Apnea 124
    Anesthetic Management 124
    Future Directions 124
    References 124
    14 - Anesthesia for Upper Gastrointestinal Endoscopy 126
    Patient Populations Presenting for Upper Gastrointestinal Endoscopic Procedures 126
    Preprocedure Evaluation 126
    Anesthetic Drugs for Gastrointestinal Endoscopy 127
    Airway Management 128
    Conduct of Anesthesia for Upper Gastrointestinal Endoscopy 129
    Monitoring 130
    Complications 130
    Future 130
    References 131
    15 - Anesthesia for Colonoscopy 132
    History of Anesthesia for Gastrointestinal Endoscopic Procedures 132
    General Considerations 132
    Complications 135
    Conclusion 135
    References 135
    16 - Anesthesia in the Bronchoscopy Suite 137
    Interventional Bronchoscopic Techniques 137
    Preoperative Evaluation 139
    Management of Anesthesia: Pharmacology 140
    General Anesthesia 142
    Management of Anesthesia: Airway Choice 143
    Management of Anesthesia: Oxygenation and Ventilation 145
    Management of Anesthesia: Other Considerations 146
    Management of Complications 147
    Conclusion 148
    References 148
    17 - Adult Anesthesia in the Radiology Suite 151
    Radiopaque Contrast 151
    Radiation Safety 152
    General Considerations 153
    Visceral Procedures 154
    Vascular Procedures 155
    Neurological Procedures 156
    References 159
    18 - Pediatric Anesthesia in the Radiology Suite 161
    Pediatric Anesthesia in Remote Locations 161
    Preoperative Considerations 161
    Specific Areas of Radiology Procedures 164
    Conclusion 169
    References 169
    19 - Anesthesia Concerns in the Magnetic Resonance Imaging Environment 171
    Training and Personnel 171
    The Magnetic Resonance Imaging Suite 171
    Patient Selection 172
    Remote Monitoring 172
    Devices in Magnetic Resonance Imaging 172
    Anesthetic Concerns With Computerized Axial Tomography 174
    Remote Monitoring 174
    Bore of the Computed Tomography 174
    Contrast Dye Anaphylactic Response 174
    Summary 174
    References 175
    20 - Scheduling Anesthesia Services Outside the Operating Room 178
    Associated Background Issues 178
    Knowledge of the Procedure 179
    The Schedule 179
    Summary 182
    References 182
    21 - Financial and Operational Analysis for Non–Operating Room Anesthesia 183
    Market Analysis 183
    Competitive Landscape 184
    Comparative Advantages 185
    Financial Considerations 185
    An Example Analysis 186
    Operational Infrastructure 187
    Conclusion 189
    References 189
    22 - Anesthesia and Competitive Strategies 190
    Practice Patterns in Non–Operating Room Sedation 190
    Propofol Use by Nonanesthesiologists 191
    Safety of Propofol in the Non–Operating Room Setting 192
    Economic Considerations 194
    Policy Considerations and Guidelines for the Use of Propofol 195
    Moderate Sedation 196
    Other Modalities 196
    Conclusion 197
    References 197
    23 - Development of Future Systems 200
    Evolution of Automated or Computer-Assisted Systems 201
    Conclusion 203
    References 203
    24 - Novel Staffing Coverage for Anesthesia Outside the Operating Room 205
    Complexity as the Norm 205
    Personnel for Anesthesia Services 206
    How are Practice Models Determined? 207
    Novel Anesthesia Models for Outside the Operating Room 208
    Conclusion 209
    References 209
    Appendix - Relevant American Society of Anesthesiologists Guidelines 211
    Definitions and Standards 211
    Monitoring and Equipment 211
    Relevant American Society of Anesthesiologists Guidelines 211
    Index 247
    IBC IBC