BOOK
Sedation and Monitoring in Gastrointestinal Endoscopy, An Issue of Gastrointestinal Endoscopy Clinics of North America, E-Book
(2016)
Additional Information
Book Details
Abstract
In this issue an impressive group of contributors at the forefront of sedation research has been assembled to provide endoscopists and dedicated nursing personnel alike a comprehensive review of important topics in the field sedation and analgesia. A discussion on the pharmacology and agents used to provide moderate and deep sedation provides the basic framework that is a crucial element in determining the driving force behind the developments in sedation and analgesia. An evidence-based approach on the use of unsedated endoscopy is also provided. Other topics included the use of propofol, patient-controlled sedation and analgesia, extended physiologic monitoring, risk management, and quality assurance as they apply to the spectrum of sedation in the endoscopy suite. Sedation and analgesia in the pediatric patient is also addressed.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Sedation and Monitoring in Gastrointestinal Endoscopy\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITOR | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Foreword: Sedation for Gastrointestinal Endoscopy: An Uneasy State of the Art\r | vii | ||
| Preface: Sedation and Monitoring in Gastrointestinal Endoscopy\r | vii | ||
| Preprocedural Assessment for Sedation in Gastrointestinal Endoscopy\r | vii | ||
| Training and Competency in Sedation Practice in Gastrointestinal Endoscopy\r | vii | ||
| Endoscopic Sedation: Medicolegal Considerations\r | vii | ||
| Non–Operating Room Anesthesia in the Endoscopy Unit\r | viii | ||
| Endoscopist-Directed Propofol\r | viii | ||
| Extended Monitoring during Endoscopy\r | viii | ||
| Sedation and Monitoring in the Pediatric Patient during Gastrointestinal Endoscopy\r | viii | ||
| Sedation Challenges: Obesity and Sleep Apnea\r | ix | ||
| Sedation in the Ambulatory Endoscopy Center: Optimizing Safety, Expectations and Throughput \r | ix | ||
| Quality Assurance in the Endoscopy Suite: Sedation and Monitoring \r | ix | ||
| Computer-Assisted and Patient-Controlled Sedation Platforms\r | ix | ||
| On the Horizon: The Future of Procedural Sedation\r | x | ||
| GASTROINTESTINAL ENDOSCOPY CLINICS\rOF NORTH AMERICA\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| October 2016 | xi | ||
| January 2017 | xi | ||
| April 2017 | xi | ||
| RECENT ISSUES | xi | ||
| April 2016 | xi | ||
| January 2016 | xi | ||
| October 2015 | xi | ||
| Foreword: Sedation for Gastrointestinal Endoscopy: An Uneasy State of the Art\r | xiii | ||
| Preface: Sedation and Monitoring in Gastrointestinal Endoscopy\r | xv | ||
| Preprocedural Assessment for Sedation in Gastrointestinal Endoscopy | 433 | ||
| Key points | 433 | ||
| INTRODUCTION | 433 | ||
| THE ANESTHESIA APPROACH TO PREPARATION FOR A PROCEDURE | 433 | ||
| CONTRAST BETWEEN THE ENDOSCOPY SUITE AND THE OPERATING ROOM | 434 | ||
| GASTROINTESTINAL ENDOSCOPY PROCEDURES | 434 | ||
| THE GASTROINTESTINAL ILLNESSES THAT REQUIRES ENDOSCOPY | 435 | ||
| ALTERED GASTROINTESTINAL MOTILITY | 435 | ||
| INFECTION | 435 | ||
| BILIARY AND PANCREATIC DISEASES | 435 | ||
| COMORBIDITY | 436 | ||
| Cardiovascular Diseases | 436 | ||
| Pulmonary Disease | 437 | ||
| Neurologic Diseases | 437 | ||
| Renal Disease | 437 | ||
| Airway Examination | 438 | ||
| THE GOALS OF SEDATION | 438 | ||
| COMPLICATIONS OF SEDATION FOR GASTROINTESTINAL ENDOSCOPY | 439 | ||
| SUMMARY | 439 | ||
| REFERENCES | 439 | ||
| Training and Competency in Sedation Practice in Gastrointestinal Endoscopy | 443 | ||
| Key points | 443 | ||
| NEED FOR SEDATION TRAINING | 443 | ||
| CURRENT GUIDELINES | 444 | ||
| TRAINING IN PREPROCEDURE MANAGEMENT | 445 | ||
| Risk Assessment | 445 | ||
| Special Circumstances | 445 | ||
| Obtaining Informed Consent and Documentation | 446 | ||
| TRAINING IN SEDATION ADMINISTRATION | 446 | ||
| Level of Sedation | 446 | ||
| Pharmacology and Medication Administration | 448 | ||
| Propofol | 449 | ||
| Intraprocedural Monitoring | 450 | ||
| Managing Adverse Effects | 450 | ||
| TRAINING IN POSTSEDATION CARE | 452 | ||
| ASSESSMENT OF COMPETENCY | 453 | ||
| Role of Simulation in Competency Assessment | 454 | ||
| SUMMARY | 455 | ||
| REFERENCES | 455 | ||
| Endoscopic Sedation | 463 | ||
| Key points | 463 | ||
| MALPRACTICE LAW REVIEW | 463 | ||
| Risk Management | 463 | ||
| Tort of Negligence | 463 | ||
| Standard of Care | 464 | ||
| Guidelines | 464 | ||
| Informed Consent | 464 | ||
| Material risks | 464 | ||
| Vicarious Liability | 464 | ||
| RISK MANAGEMENT | 465 | ||
| CONSENT ISSUES | 465 | ||
| POSSIBLE WITHDRAWAL OF CONSENT | 465 | ||
| STANDARD OF CARE FOR MONITORING SEDATION | 467 | ||
| USE OF ANESTHESIA PERSONNEL FOR ENDOSCOPIC SEDATION | 467 | ||
| NEW AGENTS, DEVICES, AND SYSTEMS | 467 | ||
| SUMMARY | 468 | ||
| REFERENCES | 468 | ||
| Non–Operating Room Anesthesia in the Endoscopy Unit | 471 | ||
| Key points | 471 | ||
| INTRODUCTION | 471 | ||
| SELECTION OF LOCATION | 472 | ||
| SELECTION OF THE ANESTHETIC TECHNIQUE | 472 | ||
| MEDICATIONS COMMONLY USED FOR ANXIOLYSIS/CONSCIOUS SEDATION | 474 | ||
| Benzodiazepines | 474 | ||
| Opioids | 475 | ||
| Meperidine | 476 | ||
| Fentanyl | 476 | ||
| MEDICATIONS COMMONLY USED FOR DEEP SEDATION/GENERAL ANESTHESIA | 476 | ||
| Propofol | 476 | ||
| Dexmedetomidine | 477 | ||
| Ketamine | 477 | ||
| NEWER MEDICATIONS IN THE HORIZON | 477 | ||
| ANESTHETIC TECHNIQUES | 477 | ||
| INDICATIONS FOR ANESTHESIA SERVICES | 478 | ||
| OTHER ADJUNCTS | 478 | ||
| PROPER PREPROCEDURE EVALUATION AND PREPROCEDURAL OPTIMIZATION OF COMORBIDITIES | 479 | ||
| PROPER AND APPROPRIATE SELECTION OF THE PROVIDERS | 480 | ||
| Anesthesia Staff | 480 | ||
| Support Staff and Personnel | 480 | ||
| Education of Nonanesthesia Personnel for Sedation | 480 | ||
| PROTOCOLS | 480 | ||
| POSTANESTHESIA CARE | 481 | ||
| COMPLICATIONS OF SEDATION AND ANESTHESIA | 481 | ||
| SUMMARY | 481 | ||
| REFERENCES | 481 | ||
| Endoscopist-Directed Propofol | 485 | ||
| Key points | 485 | ||
| TERMINOLOGY SURROUNDING ENDOSCOPIST-DIRECTED PROPOFOL | 485 | ||
| BASIC PRINCIPLES OF ENDOSCOPIST-DIRECTED PROPOFOL | 486 | ||
| SAFETY HISTORY | 487 | ||
| THE POLITICS OF ENDOSCOPIST-DIRECTED PROPOFOL | 487 | ||
| THE FUTURE | 490 | ||
| SUMMARY | 490 | ||
| REFERENCES | 490 | ||
| Extended Monitoring during Endoscopy | 493 | ||
| Key points | 493 | ||
| BACKGROUND | 493 | ||
| DIRECT MONITORING AND PERSONNEL | 495 | ||
| HEMODYNAMIC MONITORING | 496 | ||
| Heart Rate and Blood Pressure Monitoring | 496 | ||
| Electrocardiography | 496 | ||
| MONITORING OXYGENATION | 497 | ||
| Sedation and Monitoring in the Pediatric Patient during Gastrointestinal Endoscopy | 507 | ||
| Key points | 507 | ||
| INTRODUCTION | 507 | ||
| GOALS AND LEVELS OF SEDATION FOR PEDIATRIC GASTROINTESTINAL PROCEDURES | 510 | ||
| UNSEDATED PROCEDURES | 512 | ||
| PATIENT RISK STRATIFICATION AND AIRWAY ASSESSMENT | 512 | ||
| PATIENT POSITIONING | 513 | ||
| USE OF A LARYNGEAL MASK AIRWAY | 513 | ||
| PATIENT MONITORING | 514 | ||
| COMMON SEDATIVES USED FOR CHILDREN UNDERGOING ENDOSCOPY | 514 | ||
| Fentanyl | 516 | ||
| Midazolam | 516 | ||
| Ketamine | 516 | ||
| Propofol | 517 | ||
| Indications for endotracheal intubation with administration of propofol | 517 | ||
| Propofol infusion without endotracheal intubation for pediatric endoscopy | 517 | ||
| Anticipatory guidance for propofol sedation for pediatric endoscopy | 518 | ||
| Propofol sedation for pediatric colonoscopy | 518 | ||
| Emergence from propofol sedation | 519 | ||
| Propofol with endotracheal intubation | 519 | ||
| Propofol for very small pediatric patients | 520 | ||
| Nonanesthesiologist-administered propofol for children | 520 | ||
| RESCUE STRATEGIES FOR COMPLICATIONS OF SEDATION | 520 | ||
| FUTURE DIRECTIONS OF SEDATION FOR PEDIATRIC ENDOSCOPY | 521 | ||
| REFERENCES | 521 | ||
| Sedation Challenges | 527 | ||
| Key points | 527 | ||
| OBESITY AND SEDATION | 528 | ||
| Nonbariatric Obese Population | 528 | ||
| Bariatric Population | 531 | ||
| OBSTRUCTIVE SLEEP APNEA AND SEDATION | 532 | ||
| SUMMARY | 535 | ||
| REFERENCES | 535 | ||
| Sedation in the Ambulatory Endoscopy Center | 539 | ||
| Key points | 539 | ||
| OPTIMIZING SAFETY—PREPROCEDURE | 539 | ||
| PATIENT EXPECTATIONS—SEDATION AND ANALGESIA | 541 | ||
| MEDICATIONS | 542 | ||
| Benzodiazepines | 542 | ||
| Opioids | 542 | ||
| Propofol | 543 | ||
| Quality Assurance in the Endoscopy Suite | 553 | ||
| Key points | 553 | ||
| INTRODUCTION | 553 | ||
| QUALITY-ASSURANCE COMPETENCIES | 554 | ||
| Preprocedure Assessment | 554 | ||
| Informed consent | 554 | ||
| History and physical examination | 554 | ||
| Risk assessment | 554 | ||
| Sedation plan | 555 | ||
| Team pause | 555 | ||
| Intraprocedure Assessment | 556 | ||
| Monitoring | 556 | ||
| Complication management | 556 | ||
| Postprocedure Assessment | 557 | ||
| Discharge criteria | 557 | ||
| Patient instructions | 557 | ||
| Adverse events | 557 | ||
| Patient satisfaction | 557 | ||
| COMPETENCY IN ENDOSCOPIC SEDATION | 558 | ||
| Training | 558 | ||
| Pharmacology | 558 | ||
| Personnel | 560 | ||
| SUMMARY | 560 | ||
| REFERENCES | 560 | ||
| Computer-Assisted and Patient-Controlled Sedation Platforms | 563 | ||
| Key points | 563 | ||
| INTRODUCTION | 563 | ||
| SEDATION MEDICATIONS APPROPRIATE FOR COMPUTER AND PATIENT CONTROL | 564 | ||
| PATIENT MONITORING AND OXYGEN DELIVERY FOR COMPUTER- OR PATIENT-CONTROLLED SEDATION | 566 | ||
| Physiologic Monitoring | 566 | ||
| Electroencephalogram Monitoring | 567 | ||
| An Automated Responsiveness Monitor | 567 | ||
| Ocular Microtremor Monitor | 568 | ||
| Oxygen Delivery | 568 | ||
| COMPUTER-CONTROLLED SEDATION SYSTEMS | 569 | ||
| Computer-Assisted Personalized Sedation | 569 | ||
| Target-Controlled Infusion | 571 | ||
| Systems in Development | 571 | ||
| PATIENT-CONTROLLED INFUSION SYSTEMS | 572 | ||
| SUMMARY | 573 | ||
| REFERENCES | 574 | ||
| On the Horizon | 577 | ||
| Key points | 577 | ||
| INTRODUCTION | 577 | ||
| TRAINING IN SEDATION FOR ENDOSCOPY | 578 | ||
| SEDATION AGENTS | 581 | ||
| Propofol | 581 | ||
| Alternative Sedation Agents | 583 | ||
| Dexmedetomidine | 583 | ||
| Remifentanil | 583 | ||
| Ketamine | 584 | ||
| Fospropofol | 584 | ||
| Remimazolam | 584 | ||
| SEDATION IN SPECIAL POPULATIONS UNDERGOING GASTROINTESTINAL ENDOSCOPY | 584 | ||
| PSYCHOMOTOR RECOVERY | 585 | ||
| QUALITY IN ENDOSCOPY SEDATION | 587 | ||
| COMPLICATIONS | 588 | ||
| SUMMARY | 589 | ||
| REFERENCES | 589 |