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.
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 |