Bell G D
Ipswich Hospital, U.K.
Scand J Gastroenterol Suppl. 1990;179:18-23.
Better training standards and widespread adoption of monitoring equipment has resulted in a considerable drop in anaesthetic-related deaths. This fall, however, has not been reflected in the field of endoscopy, in which over 50% of the complications and deaths appear to be due to cardiopulmonary problems, suggesting the involvement of sedative drugs. Improvements in monitoring could substantially reduce these problems. Staff should be fully trained in endoscopic, sedative, and resuscitation procedures; equipment and drugs for resuscitation should be immediately to hand; any risk factors in patients who are to undergo endoscopy should be identified, and, when necessary, additional monitoring and safety procedures should be followed. Pulse oximeters can detect oxygen desaturation very early and should be used where risk factors have been identified. Use of oximetry and continuous ECG monitoring will improve the sensitivity of clinical monitoring and may reduce the number of adverse events encountered in endoscopy. Use of supplemental oxygen should be considered.
更好的培训标准以及监测设备的广泛应用已使麻醉相关死亡人数大幅下降。然而，这种下降并未在内窥镜检查领域得到体现，其中超过50%的并发症和死亡似乎是由心肺问题导致的，这表明镇静药物可能与此有关。监测方面的改进可大幅减少这些问题。工作人员应接受关于内窥镜检查、镇静和复苏程序的全面培训；复苏设备和药物应随时可用；应识别即将接受内窥镜检查患者的任何风险因素，必要时应遵循额外的监测和安全程序。脉搏血氧仪能够非常早期地检测到氧饱和度下降，在已识别出风险因素的情况下应使用。使用血氧测定法和连续心电图监测将提高临床监测的敏感性，并可能减少内窥镜检查中出现的不良事件数量。应考虑使用补充氧气。
