International anesthesiology clinics
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When performing IVCS, one must never forget the primary goal of providing patient comfort without compromising cardiopulmonary function or the patient's ability to react purposely to verbal commands and physical stimuli. When it is anticipated that required sedation will lead to loss of protective airway reflexes, such patients require a greater level of care than exists with IVCS. Deep sedation is a complication of IVCS and must be avoided. ⋯ The use of the narcotic antagonist naloxone and the benzodiazepine antagonist flumazenil should be scrutinized because they should be reserved for the unusual situation in which excessive cardiopulmonary depression occurs. Maintenance of a patent airway and stable cardiovascular function in a patient who can respond to verbal commands and physical stimuli is the primary goal of IVCS. With the agents discussed in this chapter, this goal is easily obtained, keeping the principles just mentioned in mind with all the appropriate monitoring guidelines discussed elsewhere in this text.
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Choose your patients carefully. Check and understand your equipment. Be vigilant and prepared for the unexpected event. ⋯ Have clearly defined personal and departmental plans to deal with emergency situations. Use medication judiciously; you cannot take it out but you can always give more. The use of reversal agents should never be routine.