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
ReviewExtended/advanced monitoring techniques in gastrointestinal endoscopy.
The practice of sedation and analgesia is under increasing scrutiny by numerous regulatory agencies, with the aim of making these procedures safer and reducing the incidence of cardiopulmonary complications during GI endoscopy. As we move toward more evidence-based medicine, new technologies will have to be assessed in a manner that demonstrates their efficacy and utility in clinical practice. Although there have been no controlled studies examining whether more intensive monitoring during endoscopy improves outcomes, extended monitoring with capnography seems to offer an advantage over conventional monitoring in that, by providing a real-time indication of any change in adequate ventilation before oxygen desaturation occurs, it can detect early phases of respiratory depression, which can allow a more precise and safer titration of medications. ⋯ Their potential role in improving sedation practice during endoscopy needs to be confirmed by controlled trials. If we consider the lack of proven efficacy of these emerging monitoring techniques in reducing the adverse outcomes associated with sedation and analgesia, the importance of appropriate monitoring cannot be overemphasized. However, it is vital for the endoscopist to be thoroughly familiar with the type of sedation chosen, to be able to recognize the various levels of sedation, and, above all, to rescue patients should they unintentionally progress to a deeper level of sedation than intended.
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Gastrointest. Endosc. Clin. N. Am. · Apr 2004
ReviewA nursing perspective on sedation and nurse-administered propofol for endoscopy.
Although the role of nurses in endoscopic sedation and monitoring varies widely, our experience has been that an active role of nurses in the administration of sedation and in patient monitoring has been safe for patients, has allowed expansion of the use of propofol in GI endoscopy in a cost-effective fashion, and has been satisfying to patients and nurses. In addition, in some instances nurse administration of sedation has improved the efficiency of the endoscopy unit. The role of nurses in endoscopic sedation and monitoring continues to develop, and we are enthusiastic about an active role for nurses.
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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.