Department of Radiology, LSU School of Medicine, 1542 Tulane Ave, 3rd Floor, New Orleans, LA 70112, USA.
Radiographics. 2013 Mar-Apr;33(2):E47-60. doi: 10.1148/rg.332125012.
Radiologists, like other physicians, need to know how to use sedatives, analgesics, and local anesthetics; however, their exposure to patients requiring discomfort control is limited, not just during residency but also in postgraduate practice. The purpose of this article is to provide a reference guide for radiologists who need pertinent and ready information on discomfort control. The authors discuss policies and standards that the Joint Commission has established for sedation providers; also discussed are the clinical pharmacology and dosage recommendations for the sedative, analgesic, anesthetic, and reversal agents that radiologists are most likely to use. Monitored anesthesia care and patient-controlled analgesia pumps, and in what circumstances they may be appropriate, are discussed. Anesthesia consultations are not uncommon when a nonanesthesiologist needs either of these services. Stiff chest syndrome, serotonin release syndrome, and systemic toxicity due to local anesthesia, all life-threatening conditions that sedation and analgesia providers may encounter, are discussed. The causes of these conditions and their necessary treatments are included in the discussion, along with cases in which a nonanesthesiologist may need an anesthesia consultation. It is important to understand that the control of pain and anxiety are not mutually exclusive but can occur either separately or together; when an agent that controls anxiety and an agent that controls pain are given together, the overall effect is synergistic. It is also important to understand the concept of multimodal analgesia; this is the use of opioids and nonopioids together to take full advantage of the analgesic effects of each component while minimizing potential side effects. Radiologists are fully capable of providing effective and safe pain control on their own and with the assistance of an anesthesiologist.
放射科医生与其他医生一样，需要知道如何使用镇静剂、镇痛药和局部麻醉剂；然而，他们接触需要控制不适的患者的机会不仅在住院期间有限，而且在毕业后的实践中也有限。本文的目的是为需要有关不适控制的相关和现成信息的放射科医生提供参考指南。作者讨论了联合委员会为镇静剂提供者制定的政策和标准；还讨论了放射科医生最有可能使用的镇静剂、镇痛药、麻醉剂和逆转剂的临床药理学和剂量建议。讨论了监测麻醉护理和患者自控镇痛泵，以及在什么情况下它们可能是合适的。当非麻醉医生需要这些服务中的任何一种时，麻醉咨询并不罕见。讨论了可能会遇到的危及生命的情况，包括僵硬胸综合征、血清素释放综合征和局部麻醉引起的全身毒性，镇静和镇痛提供者可能会遇到这些情况。讨论了这些情况的原因及其必要的治疗方法，以及非麻醉医生可能需要麻醉咨询的情况。了解疼痛和焦虑的控制不是相互排斥的，但可以单独或一起发生是很重要的；当控制焦虑的药物和控制疼痛的药物一起使用时，整体效果是协同的。了解多模式镇痛的概念也很重要；这是使用阿片类药物和非阿片类药物的联合使用，以充分利用每个成分的镇痛效果，同时最大限度地减少潜在的副作用。放射科医生完全有能力在没有麻醉师协助的情况下独自提供有效和安全的疼痛控制。
