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Sedation and Monitoring in Gastrointestinal Endoscopy, An Issue of Gastrointestinal Endoscopy Clinics of North America, E-Book

Sedation and Monitoring in Gastrointestinal Endoscopy, An Issue of Gastrointestinal Endoscopy Clinics of North America, E-Book

John Vargo

(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