Anesthesiology clinics
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Traditionally, sedation for gastrointestinal endoscopic procedures was provided by the gastroenterologist. Increasingly, however, complex procedures are being performed on seriously ill patients. As a result, anesthesiologists now are providing anesthesia and sedation in the gastrointestinal endoscopy suite for many of these patients. This article reviews the challenges encountered in this environment and anesthetic techniques that can be used successfully for these procedures.
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There is no need to reinvent the wheel to determine the need for vigilant monitoring in outside of the operating room (OOR) settings. Anesthesiologists have evolved a robust system of monitoring standards based on decades of experience in operating room environments. Every OOR location should be thoroughly evaluated and monitoring standards implemented. The standards should be periodically reviewed to avert morbidity.
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Achieving fundamental reform of the health care system to improve patient outcomes will take decades of effort and a major shift in financial, medical, and political behaviors that have built up since the beginning of health insurance in the United States. To the extent that the present payment systems contribute to the high cost, poor quality, and lack of accountability that characterizes today's health care delivery system, there is hope that reforms are within reach.
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Performing an anesthetic in a procedure suite instead of in the operating room can be extremely challenging for the anesthetist. Not only are the procedures performed outside of the operating room becoming increasingly more complex but also patient acuity is increasing. In some cases, the out-of-operating room procedure may be selected as a less risky alternative to an operating room procedure in an extremely high-risk patient. Effective preprocedure evaluation and preparation are critical to achieve optimal clinical outcomes and maximal operational efficiency in these areas.
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The safety of anesthesia delivered in the operating room is enhanced by the standardization and reliability built into that environment, which has prescriptive and detailed protocols for almost every procedure performed. Experienced anesthesiologists come to rely on these operating room characteristics to support the delivery of safe care. Anesthesiologists giving anesthesia outside the operating room often find themselves in settings that lack this rigor and that therefore challenge safety. This article describes the basic concepts in safety, with an emphasis on teamwork and communication, and then discusses how their application ensures safe care in remote locations.