Anesthesiology clinics
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Anesthesiology clinics · Mar 2009
The evolution of the anesthesiologist: novel perioperative roles and beyond.
Delivery of the spectrum of anesthesia from sedation to general anesthesia for patients undergoing procedures outside of the operating room (OR) poses several problems not encountered in the OR. These include limited time to assess the patient and often no time to obtain consultations for medical conditions that may be outside of the usual purview of an anesthesiologist, such as initial management of infections, diabetic ketoacidosis or hyperosmotic hyperglycemic state, inadequately managed cardiovascular disease, and toxic ingestions. Anesthesiologists trained in critical care usually have more experience with the initial assessment and management of patients with such conditions. It can be argued that because procedures performed outside of the OR are becoming more common, the curriculum for anesthesia residencies should be modified to provide more training in conditions typically assessed and managed by internists or medical subspecialists.
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Anesthesiology clinics · Mar 2009
Traditional fee-for-service Medicare payment systems and fragmented patient care: the backdrop for non-operating room procedures and anesthesia services.
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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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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A successful population-based colorectal cancer screening requires efficient colonoscopy practices that incorporate high throughput, safety, and patient satisfaction. There are several different modalities of nonanesthesiologist-administered sedation currently available and in development that may fulfill these requirements. ⋯ Many of these procedures will also require the anesthesiologist's knowledge, skills, abilities, and experience to ensure optimal procedure results and good patient outcomes. The goal of this review is (1) to provide a gastroenterology perspective on the use of propofol in gastroenterology endoscopic practice, and (2) to describe newer GI endoscopy procedures that gastroenterologists perform that might involve anesthesiologists.