Gastrointestinal endoscopy clinics of North America
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Gastrointest. Endosc. Clin. N. Am. · Apr 2004
ReviewUpdate and review of moderate and deep sedation.
The administration of sedation/analgesia to allow patients to tolerate diagnostic or therapeutic procedures and tests is a fact of life. Approximately 200,000,000 such sedations are administered every year in the United States. ⋯ Clinicians from many specialties now safely and effectively administer sedation. With attention to updated guidelines and concepts, as outlined in this article, the safety and efficacy of sedation/analgesia can and should be excellent.
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Gastrointest. Endosc. Clin. N. Am. · Apr 2004
ReviewPatient-controlled analgesia and sedation in gastrointestinal endoscopy.
Variations in pain threshold, drug tolerance, and visceral sensitivity among patients make it difficult to anticipate the appropriate dose of sedation for gastrointestinal endoscopy. Propofol was recently introduced for sedation in endoscopy and has a rapid onset and offset of action, making it an ideal substance for patient-controlled administration. Several controlled trials have demonstrated that during colonoscopy, patient-controlled application of propofol alone or in combination with various opioids is effective,safe, and yields high patient satisfaction. Target-controlled infusion of propofol has shown encouraging results for prolonged upper endoscopy procedures like endoscopic retrograde cholangio pancreatography.
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Gastrointest. Endosc. Clin. N. Am. · Apr 2004
ReviewQuality assurance in the endoscopy suite: sedation and monitoring.
Education and training is the first line of defense in maintaining patient safety and providing quality care in the Endoscopy suite. Ensuring that the health care provider is well trained minimizes the risk to the patient. ⋯ Monitoring compliance to standards with continual feedback of results allows the endoscopist to evaluate performance on an ongoing basis. The endoscopist has no choice but to become an active participant in the quality assurance process to improve the quality and value of their work.
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Gastrointest. Endosc. Clin. N. Am. · Apr 2004
ReviewEfficacy, safety, and limitations in current practice of sedation and analgesia.
The ease and availability of endoscopy as a diagnostic and therapeutic modality for gastrointestinal disorders has greatly increased the number of procedures performed in the United States. One of the main factors in achieving a flawless procedure is the use of sedation and analgesia in endoscopy. This article examines the efficacy, safety, and limitations inherent in the current practice of sedation and analgesia.
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Gastrointest. Endosc. Clin. N. Am. · Apr 2004
ReviewExtended/advanced monitoring techniques in gastrointestinal endoscopy.
The practice of sedation and analgesia is under increasing scrutiny by numerous regulatory agencies, with the aim of making these procedures safer and reducing the incidence of cardiopulmonary complications during GI endoscopy. As we move toward more evidence-based medicine, new technologies will have to be assessed in a manner that demonstrates their efficacy and utility in clinical practice. Although there have been no controlled studies examining whether more intensive monitoring during endoscopy improves outcomes, extended monitoring with capnography seems to offer an advantage over conventional monitoring in that, by providing a real-time indication of any change in adequate ventilation before oxygen desaturation occurs, it can detect early phases of respiratory depression, which can allow a more precise and safer titration of medications. ⋯ Their potential role in improving sedation practice during endoscopy needs to be confirmed by controlled trials. If we consider the lack of proven efficacy of these emerging monitoring techniques in reducing the adverse outcomes associated with sedation and analgesia, the importance of appropriate monitoring cannot be overemphasized. However, it is vital for the endoscopist to be thoroughly familiar with the type of sedation chosen, to be able to recognize the various levels of sedation, and, above all, to rescue patients should they unintentionally progress to a deeper level of sedation than intended.