Gastrointestinal endoscopy clinics of North America
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Gastrointest. Endosc. Clin. N. Am. · Jan 2005
ReviewEndoscopic ultrasound-guided fine-needle injection.
With the development of linear array echoendoscopes and the ability to perform endoscopic ultrasound (EUS)-guided fine-needle aspiration, the delivery of therapeutic agents with fine-needle injection (FNI) emerged. EUS-guided FNI is an attractive delivery system because of its minimal invasiveness and low complication rate. ⋯ The most exciting area of interest involves the delivery of antitumor agents in patients with locally advanced cancer, such as cancer of the pancreas or esophagus. The involvement of EUS-guided FNI in tumor therapy adds a host of potential new applications that continue to swing the pendulum of EUS from a diagnostic to a therapeutic modality.
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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.