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This is a review of basic principles applicable to the use of propofol by trained endoscopists and nurses for endoscopy, without the involvement of an anesthesia specialist (an anesthesiologist or certified registered nurse anesthetist). The review also explicitly describes the nature of the...
This chapter is concerned with “extended monitoring” and “advanced sedation” in gastroenterology. Topics discussed include capnography, monitoring depth of sedation, and computer-assisted propofol sedation. Although classical “hands-on” and “eyes-on” monitoring methods remain...
The continued rapid expansion of office-based surgery and anesthesia (OBS/OBA) makes it a new frontier of healthcare. Though its early years were somewhat marred by some negative publicity and bad outcomes, oversight and regulation by professional societies, governments, and private industry has...
Respiratory obstruction is a frequent consequence of sedation due to the collapsibility of the velopharynx. Several approaches are available to eliminate this obstruction, including CPAP, mandibular advancement, nasal airways, and laryngeal mask airways. Practical approaches to the use of these...
The control of administration of drugs such as propofol is a task that is difficult to master. Two approaches to this task have emerged—target-controlled infusion, and patient-controlled sedation. In the first, a set point for drug in a hypothetical effect site is specified, and the controller...
Spontaneous breathing is the default mode of ventilation for procedures in gastrointestinal (GI) endoscopy. Sedative–hypnotic medications profoundly impair respiratory control and airway patency. Fundamental physiology of hypoventilation is reviewed in the context of the patient presenting for...
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