ebook img

Non-Operating Room Anesthesia PDF

250 Pages·2014·38.97 MB·English
Save to my drive
Quick download
Download
Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.

Preview Non-Operating Room Anesthesia

Non–Operating Room Anesthesia Mark S. Weiss, MD Assistant Professor of Anesthesiology and Critical Care Director of Inpatient Anesthesia Endoscopy Services Perelman School of Medicine Hospital of the University of Pennsylvania Philadelphia, Pennsylvania Lee A. Fleisher, MD Robert D. Dripps Professor and Chair of Anesthesiology and Critical Care Professor of Medicine Perelman School of Medicine Senior Fellow, Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia, Pennsylvania 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 NON–OPERATING ROOM ANESTHESIA ISBN: 978-1-4557-5415-1 Copyright © 2015 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies, and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such infor- mation or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowl- edge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume any liability for any injury and/or damage to persons or property as a matter of products liability, neg- ligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas con- tained in the material herein. Library of Congress Cataloging-in-Publication Data Non–operating room anesthesia / [edited by] Mark S. Weiss, Lee A. Fleisher. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4557-5415-1 (hardcover) I. Weiss, Mark S. (Mark Steven), editor. II. Fleisher, Lee A., editor. [DNLM: 1. Anesthesia--standards. 2. Process Assessment (Health Care)--methods. WO 200] RD81 617.9’6--dc23 2014014682 Executive Content Strategist: William Schmitt Content Development Specialist: Lisa Barnes Publishing Services Manager: Jeff Patterson Project Manager: Clay S. Broeker Design Direction: Louis Forgione Cover Designer: Elaine Kurie Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 This book is dedicated: to Lee Fleisher for his trust and friendship. to my aunt, Lillian Brick, who is my sunshine. to my mother, Minnette Weiss, who has always been so supportive. to my father, Frederick Weiss, who was always there to guide me. to my sons, Isaac, Noah, and Henry David. And this book is dedicated to the love of my life, Paulette Marie Lambert. MSW This book is dedicated to my wife, Renee, and my children, Jessica and Matthew, for supporting me in my career while ensuring that I understand what is truly important. LAF About the Authors Mark S. Weiss, MD, is an Assistant Professor of Anesthe- Lee A. Fleisher, MD, is the Robert D. Dripps Professor and siology and Critical Care at the University of Pennsylva- Chair of Anesthesiology and Critical Care and a Professor nia’s Perelman School of Medicine. He received his medical of Medicine at the University of Pennsylvania’s Perelman degree from the University of Cincinnati and completed School of Medicine. He received his medical degree from the his residency training at Yale University. His focus is on State University of New York at Stony Brook, from which perioperative management of high-risk patients, with an he received the Distinguished Alumni Award in 2011. emphasis on non–operating room anesthesia (NORA). He is His research focuses on perioperative cardiovascular risk currently the director of Inpatient Endoscopy Services at the assessment and reduction and the measurement of qual- University of Pennsylvania. ity of care, and he has received numerous federal, industry, and foundation grants related to these subjects. He is Presi- dent of the Association of University Anesthesiologists. He is a member of the Consensus Standards Advisory Commit- tee of the National Quality Forum and of the Administrative Board of the Council of Faculty and Academic Specialties of the Association of American Medical Colleges. In 2007, he was elected to membership of the Institute of Medicine of the National Academy of Sciences. v Contributors Rose Campise-Luther, MD, FAAP Anil Gupta, MD, FRCA, PhD Assistant Professor Associate Professor Pediatric Anesthesiology Department of Anesthesiology and Intensive Care Medical College of Wisconsin Institution for Medicine and Health Milwaukee, Wisconsin Örebro, Sweden Thomas Cutter, MD, MAEd Manon Hache, MD Professor Assistant Professor Department of Anesthesia and Critical Care Department of Anesthesiology University of Chicago Columbia University Medical Center Chicago, Illinois New York, New York Christina D. Diaz, MD Eric A. Harris, MD, MBA Assistant Professor Associate Professor of Clinical Anesthesiology Pediatric Anesthesiology Department of Anesthesiology, Perioperative Medicine, Medical College of Wisconsin and Pain Management Milwaukee, Wisconsin University of Miami, Miller School of Medicine Miami, Florida Karen B. Domino, MD, MPH Professor Jennifer E. Hofer, MD Department of Anesthesiology and Pain Medicine Assistant Professor University of Washington School of Medicine Department of Anesthesia and Critical Care Seattle, Washington University of Chicago Chicago, Illinois Richard E. Galgon, MD, MS Assistant Professor E. Heidi Jerome, MD Department of Anesthesiology Associate Professor University of Wisconsin School of Medicine and Public Department of Anesthesiology and Pediatrics Health Columbia University Medical Center Madison, Wisconsin New York, New York Esther D. Garazi, MD Max Kanevsky, MD, PhD Department of Anesthesia Assistant Professor of Anesthesia Perioperative and Pain Medicine Division of Cardiovascular Anesthesia Stanford University School of Medicine Stanford University School of Medicine Stanford, California Stanford, California Gregory G. Ginsberg Meghan Lane-Fall, MD, MSHP Professor of Medicine Assistant Professor of Anesthesiology and Critical Care Director of Endoscopy Department of Anesthesiology and Critical Care Gastroenterology Division University of Pennsylvania Hospital of the University of Pennsylvania Philadelphia, Pennsylvania Philadelphia, Pennsylvania Kelly Lebak, MD Basavana G. Goudra, MD, FRCA, FCARCSI Anesthesiologist Assistant Professor MetroHealth Medical Center Department of Anesthesiology and Critical Care Medicine University of Wisconsin—Madison Hospital of the University of Pennsylvania Madison, Wisconsin Philadelphia, Pennsylvania Jeffrey Lee, MS, MD Caitlin J. Guo, MD, MBA Assistant Professor Assistant Professor Anesthesiology Department of Anesthesia University of Wisconsin—Madison New York University Medical Center Madison, Wisconsin New York, New York vii viii Contributors Mark A. Leibel, MD Mark C. Phillips, MD Assistant Professor Assistant Professor and Medical Director, Advanced GI Department of Anesthesiology Endoscopy Anesthesia University of Wisconsin School of Medicine and Public Department of Anesthesiology Health University of Alabama at Birmingham School of Medicine Madison, Wisconsin Birmingham, Alabama Larry Lindenbaum, MD Christopher D. Press, MD Assistant Professor Department of Anesthesiology, Perioperative Department of Anesthesiology and Critical Care Medicine and Pain Medicine Medical College of Wisconsin Stanford University School of Medicine Milwaukee, Wisconsin Stanford, California Alex Macario, MD, MBA Johan Raeder, MD, PhD Professor Professor Department of Anesthesiology, Perioperative and Pain Faculty of Medicine Medicine NOR Consultant Vice-Chair for Education Department of Anaesthesiology Program Director, Anesthesia Residency Oslo University Hospital Stanford University School of Medicine Oslo, Norway Stanford, California W. Kirke Rogers, MD Jeff E. Mandel, MD, MS Associate Assistant Professor of Anesthesiology and Critical Care Department of Anesthesiology Perelman School of Medicine The University of Iowa Roy J. and Lucille A. Carver College University of Pennsylvania of Medicine Philadelphia, Pennsylvania Iowa City, Iowa Ramon Martin, MD, PhD Daniel Rubin, MD Staff Anesthesiologist Assistant Professor Department of Anesthesiology, Perioperative and Pain Department of Anesthesia and Critical Care Medicine University of Chicago Brigham and Women’s Hospital Chicago, Illinois Assistant Professor Anesthesia John P. Scott, MD Harvard Medical School Assistant Professor Boston, Massachusetts Department of Anesthesiology and Pediatrics Medical College of Wisconsin Julia I. Metzner, MD Milwaukee, Wisconsin Associate Professor Department of Anesthesiology and Pain Medicine Jack S. Shanewise, MD University of Washington Professor of Anesthesiology Seattle, Washington Columbia University Medical Center New York, New York Roger A. Moore, MD Clinical Associate Professor of Anesthesiology and Critical Preet Mohinder Singh, MD Care Assistant Professor Chair Emeritus, Deborah Heart and Lung Center Department of Anesthesiology and Critical Care Medicine Perelman School of Medicine Postgraduate Institute of Medical Education and Research Hospital of the University of Pennsylvania Chandigarh, India Philadelphia, Pennsylvania Scott Springman, MD Melissa L. Pant, MD Professor Clinical Associate Anesthesiology Department of Anesthesia and Critical Care University of Wisconsin—Madison University of Chicago Madison, Wisconsin Chicago, Illinois Lena S. Sun, MD E.M. Papper Professor of Pediatric Anesthesiology Department of Anesthesiology and Pediatrics Columbia University Medical Center New York, New York Contributors ix BobbieJean Sweitzer, MD Sophia van Hoff, MD Professor of Anesthesia and Critical Care Resident Department of Anesthesiology and Critical Care Department of Anesthesiology University of Chicago Dartmouth-Hitchcock Medical Center Director Lebanon, New Hampshire Anesthesia Perioperative Medicine Clinic Professor of Medicine Lindsay L. Warner, BS Department of Medicine Mayo Medical School University of Chicago Mayo Clinic Chicago, Illinois Rochester, Minnesota Pedro P. Tanaka, MD, PhD Mary Ellen Warner, MD Department of Anesthesiology, Perioperative and Associate Professor of Anesthesiology Pain Medicine Mayo Clinic Stanford University School of Medicine Rochester, Minnesota Stanford, California Nafisseh S. Warner, MD Jonathan W. Tanner, MD, PhD Mayo School of Graduate Medical Education Assistant Professor of Clinical Anesthesiology and Critical Mayo Clinic Care Rochester, Minnesota Department of Anesthesiology and Critical Care Perelman School of Medicine Mark S. Weiss, MD University of Pennsylvania Assistant Professor of Anesthesiology and Critical Care Philadelphia, Pennsylvania Director of Inpatient Anesthesia Endoscopy Services Perelman School of Medicine John M. Trummel, MD MPH Hospital of the University of Pennsylvania Assistant Professor Philadelphia, Pennsylvania Department of Anesthesiology Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire Foreword Anesthesiology has witnessed incredible advances over the outside of traditional operating room locations. At the past 3 decades. Improved patient safety has been a driving Hospital of the University of Pennsylvania, the increase in force for our advancements in medical technology, in the anesthetics delivered outside the operating room has grown expansion of our pharmacological armamentarium, and in over the past decade from a minimal number of cases yearly the development of innovative anesthetic techniques. The to a time today when over 30% of the anesthetics are given reward for these improvements is better patient outcomes in nontraditional locations. Many anesthesia departments and the ability to provide complex surgical interventions are unprepared psychologically and educationally to meet to patients that would have been impossible to perform the increasing demand for out-of–operating room care. without the anesthetic advancements. There has never There are significant manpower, economic, educational, been a better time for anesthesiologists to take the sickest and patient safety factors that need to be explored in order and most debilitated of patents of all ages through the most to operationalize an effective out-of–operating room care highly invasive and stressful procedures in such a safe and plan. However, if an anesthesia department is to continue effective manner. In the 21st century, and significantly to be viable in this changing surgical and procedural envi- due to advances in anesthetic care, surgery has also had ronment, it is imperative that the departments and anes- an increased focus on out-of-operating room procedures, thesia groups take a cooperative approach, rather than an necessitating continued anesthesia innovation for the envi- obstructive attitude, in partnering with those physicians ronment outside the operating room. Just a few decades performing the procedures. ago, it was rare that anesthesiologists were called to provide In this book, Drs. Mark Weiss and Lee Fleisher have pro- care outside the typical operating room setting; when doing vided an important tool to address both the challenges and so, it was usually limited to emergent or highly unusual cir- opportunities for anesthesiologists in providing non–operat- cumstances. Indeed, training programs primarily focused ing room anesthesia (NORA) care. As NORA continues to con- on providing the highest quality and safest care under the sume more of the time and effort of anesthesia departments, controlled environment of an operating room arena, where NORA training should become an integral part of anesthe- supplies, equipment, and personnel were readily available sia residency programs. However, until anesthesiologists do to support most medical complications. The “comfort zone” receive formal education in NORA, I believe this book will go for nearly all anesthesiologists did not extend far past the a long way in expanding the comfort zone of anesthesiologists sterile corridors of the operating room. to out-of–operating room locations. As minimally invasive Once the acknowledgment is made that out-of-operating procedures rapidly increase, it is certain that the practice of room anesthetic care has to be provided, guidelines for the anesthesia will significantly expand in nontraditional envi- delivery of that care must be established. As previously ronments and that our services will be vital for the smooth stated, providing anesthesia out of the operating room flow of patient care in all out-of–operating room settings. typically falls outside the training and comfort zone of most anesthesiologists. There are few comprehensive guidelines, Roger A. Moore, MD protocols, or educational materials tailored to the specific Clinical Associate Professor of needs of these types of anesthetics. Also, the environment Anesthesiology and Critical Care, and the techniques are unfamiliar to many anesthesiolo- Hospital of the University of Pennsylvania gists. Education and information are critical for both reduc- Past President, Society of Cardiovascular ing physician anxiety and for standardizing the procedures Anesthesiologists and practices for care outside the operating room. Past President, American Society Recent reports filed with the Anesthesia Quality Institute of Anesthesiologists indicate that many of the anesthetics today are delivered x Preface The past several years have seen advances in medical tech- It is hoped that the information presented will facilitate nology that allow physicians to treat a patient with mini- improved patient care and provide a resource for the inclu- mally invasive procedures. With increasing frequency, sion of NORA training within residency training programs. these procedures are being performed outside the tradi- This is, in many ways, an important part of the future of tional operating room environment. Non–operating room anesthesia. anesthesia (NORA) cases now comprise as many as 70% of There are many people who have worked hard to make the cases being reported to the Anesthesia Quality Institute. this project possible. We would first like to thank the profes- In spite of the exponential increase in NORA caseloads, very sionals at Elsevier who have been so wonderful to work with: little attention has been paid to this subspecialty area and Lisa Barnes, William Schmitt, Clay Broeker, and the entire even less with regard to developing guidelines, protocols, staff. We would like to thank Amy Meros, Administrative and educational materials tailored to the specific needs of Coordinator in the department, who has been patient and providing anesthesia in these settings. tireless in helping to bring this manuscript together. Finally, This book is meant to serve as an educational resource we would like to thank the authors and contributors to this in regard to issues of setup, quality control, patient care book for the many hours it takes to write a chapter. and safety, and economic viability that are specific to NORA. The contributing authors are all outstanding clini- Mark S. Weiss, MD cians who have developed expertise that relates to NORA. Lee A. Fleisher, MD xi

Description:
The demand for anesthesiologists outside of the operating room continues to grow as the number of minimally invasive procedures proliferates and the complexity of diagnostic procedures undertaken outside of the OR increase. Non-Operating Room Anesthesia is an easy-to-access, highly visual reference
See more

The list of books you might like

Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.