Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates
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Due to increased public awareness, the number of endoscopic procedures performed per year is rapidly increasing. In lieu of expanding endoscopy units, current practices are being reviewed to improve unit efficiency without compromising patient care. Changing from a traditional medication regimen of demerol/versed or fentanyl/versed to propofol for moderate sedation is currently controversial. ⋯ In this study, the use of propofol was associated with a statistically significant shorter mean procedure time (p <.001) and nonsignificant post-procedure time (p =.056) than a traditional regimen; however, a statistically significant reduction in mean times was demonstrated by changes in process (p <.001). The use of propofol demonstrated an actual total time savings of 5.3 minutes per case after the process change. This difference was not large enough for the authors to change current practice of traditional medication for moderate sedation when all other issues related to propofol were taken into consideration.
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This article uses a case study to demonstrate the proper use of Narcan (naloxone hydrochloride injection, USP) for the reversal of the effects of opiates which can occur during moderate or "conscious" sedation for procedures in the endoscopy setting. Alternative treatments for the sedation, hypotension, and respiratory depression are discussed, as are instructions and rationale for partial reversal. Guidelines to ensure patient safety are also presented.
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Upper gastrointestinal endoscopy can be performed without intravenous sedation but the evidence suggests most patients and endoscopists prefer some form of premedication. Intravenous diazepam or midazolam are used by the majority of endoscopists in the United States, though it is not common practice in Turkey where this study was conducted. ⋯ Ages of the patients ranged between 16 and 79 years (average: 41.6 +/- 12.7 years). The course of endoscopy, anterograde memory, degree of cooperation, degree of sedation, side effects, and acceptability of further intervention were evaluated by a questionnaire given to the patients and endoscopists.
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This article describes the use of interventional endoscopic ultrasonography, namely, endoscopic ultrasound-guided injection therapy for the treatment of pain. With the assistance of endoscopic ultrasonography, it is now possible to safely inject the celiac plexus with pharmacological agents to provide analgesia in painful pancreatic conditions such as cancer and chronic pancreatitis. The indications for celiac plexus injection, the procedure, required accessories, complications, and nursing care are discussed.