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Risk-seeking in healthcare
Published in Guy André Boy, Edwige Quillerou, Risk-Taking, Prevention, and Design, 2023
Although the Hippocratic method is generally successful, it is clearly an undesirable experience for patients and doctors alike. In recent years, the development of rapid-acting anesthetics has radically changed the approach toward managing this and other painful procedures. These new drugs induce anesthesia very rapidly (seconds to minutes) and wear off very rapidly (minutes), thus allowing brief procedures to be performed under sedation rather than on an awake and sensate patient. However, procedural sedation such as this carries with it low but nonzero risks of apnea (stopping breathing) and hypotension (circulatory shock), which may ultimately lead to death or irreversible brain damage. The bottom line here is that advances in care that improve the general experience of most patients may inevitably be accompanied by increases in risk that are heavily borne by a few.
Sedation, analgesia and patient observation in interventional radiology
Published in William H. Bush, Karl N. Krecke, Bernard F. King, Michael A. Bettmann, Radiology Life Support (Rad-LS), 2017
Jeffrey E. Quam, Michael A. Bettmann
Over the past few years, the scope of practice of diagnostic radiology has broadened dramatically. Coinciding with this increased capacity to image has been an increase in the ability of the radiologist to perform image-guided interventional procedures for both diagnostic and therapeutic purposes. These developments have had a tremendous positive impact on the practice of modern medicine. As a consequence of this trend, radiologists now have greater responsibility in the management of interventional patients. In addition to successfully performing the procedure itself, radiologists must prevent or limit the physical and emotional suffering of their patients. The utilization of various pharmacologic agents can achieve this by relieving anxiety, providing sedation and alleviating pain. The development of new, short-acting and reliable drugs has made sedation and analgesia simpler and safer. Consequently, the responsibility of managing these patients has been passed from anesthesiologists to radiologists. In using these agents the radiologist must be prepared to recognize and address the risks involved in their use. Although the radiologist is primarily responsible, well-trained and experienced radiology nurses and technologists must be engaged in all aspects of the procedure.
Transrectal Ultrasound (TRUS)-Guided Prostate Biopsy
Published in Ayman El-Baz, Gyan Pareek, Jasjit S. Suri, Prostate Cancer Imaging, 2018
Jennifer Fantasia, Dragan Golijanin, Boris Gershman
Contraindications to TRUS-guided prostate biopsy including active urinary infection, coagulopathy, and rectal anomalies that preclude the procedure (e.g., rectal stricture, which may result in inability to tolerate rectal introduction of the TRUS probe; or absence of rectum, as in patients with total proctocolectomy). Active urinary infection is associated with high risk of serious infectious complications. Similarly, coagulopathy can result in severe bleeding complications. Some patients may require sedation to successfully undergo the procedure, either due to concomitant ano-rectal pathology or anxiety.
Reflection efficiencies of AnaConDa-S and AnaConDa-100 for isoflurane under dry laboratory and simulated clinical conditions: a bench study using a test lung
Published in Expert Review of Medical Devices, 2021
Azzeddine Kermad, Jacques Speltz, Philipp Daume, Thomas Volk, Andreas Meiser
Sedation is an important part of the treatment of intensive care patients to relieve stress and fear. Inadequate sedation and long-term ventilation are associated with post-traumatic stress disorder [1,2]. The sedation of intensive care patients can be achieved either intravenously [3] or via inhalation [4,5]. Inhaled sedation is endorsed by the German guideline for the management of delirium, analgesia, and sedation in intensive care [6] and is also recommended from the Spanish, British, and French societies for intensive care [7–9].
Endoscopic transforaminal lumbar interbody fusion: a comprehensive review
Published in Expert Review of Medical Devices, 2019
Yong Ahn, Myung Soo Youn, Dong Hwa Heo
Endoscopic TLIF procedures can be performed without general anesthesia. In particular, percutaneous endoscopic TLIF is usually performed under local anesthesia. Use of conscious sedation reduces the risks associated with general anesthesia and facilitates real-time neurological feedback from the patient. Therefore, percutaneous endoscopic TLIF is particularly useful in elderly or medically compromised patients.