remoteAnesthesia - RemoteAnesthesia Jessica A....

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    Remote Anesthesia Jessica A. Lovich-Sapola, MD 30 November 2005
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Objectives Understanding that the standards of anesthesia care and patient monitoring are the same regardless of location. Remember that the key to efficient and safe remote anesthetic relies on open communication between the anesthesiologist and non-operating room personnel. Realize that remote locations have different safety concerns, such as radiation and powerful magnetic fields.
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2005 ABA written examination  keywords ASA basic monitoring standards MRI suite: O 2 delivery
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Content outline, joint council on in- training exam Monitored anesthesia care and sedation: ASA guidelines for sedation, sedation guidelines for non- anesthesiologists. Ambulatory anesthesia: office-based anesthesia (special considerations), safety requirements (equipment, emergency plan). Electroconvulsive therapy Radiologic procedures; CT scan; MRI: anesthetic implications/management, anesthesia in locations outside the operating room.
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Remote anesthesia Anesthesiologists are increasingly being asked to provide anesthetic care in locations outside of the OR. These locations include: radiology suites, cardiac labs, psychiatric units, GI lab, CT, MRI, and PACU. It is the responsibility of the anesthesiologist to ensure that the location meets the ASA guidelines for safety.
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1994 Guidelines for non-operating room  anesthetizing locations. Reliable oxygen source with backup. Suction source. Waste gas scavenging. Adequate monitoring equipment. Self-inflating resuscitator bag. Sufficient safe electrical outlets. Adequate light and battery-powered backup. Sufficient space. Emergency cart with defibrillator, emergency drugs, and emergency equipment. Means of reliable two-way communication. Compliance with safety and building codes.
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Remote monitoring Qualified anesthesia personnel must be present for the entire case. Continuous monitoring of patient’s oxygenation, ventilation, circulation, and temperature. Oxygen concentrations of inspired gas: low concentration alarm. Blood oxygenation: pulse oximetry. Ventilation: end-tidal carbon dioxide detection and disconnect alarm. Circulation: EKG, ABP (q 5min), invasive BP, and oximetry.
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Remote facilities and equipment Know the physical layout of the location, unfamiliar anesthetic equipment, and anesthetic implications of the procedure being performed prior to the induction of anesthesia. Verify the availability of assistance. Check piped-in gases and gas tanks. Check suction. Check power outlets (i.e. grounding and electrical requirements).
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Remote personnel Nurses and radiology techs are often less familiar with the management of anesthesia, therefore they are often unable to provide skilled assistance in an emergency
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Remote recovery care Patient must be medically stable before transport. Patient must be accompanied to the recovery
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remoteAnesthesia - RemoteAnesthesia Jessica A....

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