Gastrointestinal endoscopy clinics of North America
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Best sedation practices for pediatric endoscopy involve the consideration of many patient factors, including age, medical history, clinical status, and anxiety level, as well as physician access to anesthesia support. A recent survey of pediatric gastroenterologists suggests that endoscopist-administered intravenous (iv) sedation and anesthesiologist-administered propofol represent common sedation regimens in children. Technical advances in ventilatory monitoring are contributing to increased patient safety for all children undergoing gastrointestinal procedures, regardless of sedation type.
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Gastrointest. Endosc. Clin. N. Am. · Oct 2008
ReviewGastroenterologist-directed propofol: an update.
Gastroenterologist directed propofol has been proven safe in more than 220,000 published cases. Administration of low doses of opioid and/or benzodiazepine ("balanced propofol sedation") is the safest format for gastroenterologist directed propofol. Specific training is needed to undertake gastroenterologist directed propofol administration.
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The role of sedation in endoscopic procedures has increased and so has the demand for advances in its administration. The pursuit of new agents or administration techniques and their study specific to endoscopic nonsurgical procedures is necessary to improve patient comfort and safety. The science of moderate and deep sedation specific to endoscopy is fledgling but approaching new horizons.
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Gastrointest. Endosc. Clin. N. Am. · Oct 2008
ReviewProviding safe sedation/analgesia: an anesthesiologist's perspective.
Over the past several years office-based procedures with sedation have become increasingly more common. It must be appreciated that not all procedures are well suited for this type of environment. ⋯ Since esophagogastroduodenoscopy (EGD) and colonoscopy are relatively non-invasive, of short duration, and not associated with either fluid shifts or significant post-procedure discomfort. In appropriate patients, these procedures are well-suited to office-based practice.
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Gastrointest. Endosc. Clin. N. Am. · Oct 2007
ReviewHow many calories are necessary during critical illness?
Several nutritional alternatives exist to provide critically ill patients sufficient calories to meet metabolic demands. Intuitively, investigators, nutritionists, and clinicians have pursued the goal of providing high-calorie nutrition support, believing that this would improve outcomes. There is little evidence, however, that meeting caloric goals is of significant benefit. ⋯ This suggests that permissive underfeeding could replace the paradigm of meeting measured caloric goals. Prospective evidence to support adoption of permissive underfeeding is lacking, however. Appropriate clinical studies are necessary to prove its safety and efficacy.