Department of Anesthesiology, Columbia University Medical Center, New York, NY.
Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Columbia University Medical Center, New York, NY.
J Cardiothorac Vasc Anesth. 2019 Nov;33(11):2902-2908. doi: 10.1053/j.jvca.2019.01.006. Epub 2019 Jan 8.
The American College of Cardiology, in collaboration with the American Society of Nuclear Cardiology, Heart Rhythm Society, Mended Hearts, North American Society for Cardiovascular Imaging, Society for Cardiovascular Angiography and Interventions, Society for Cardiovascular Computed Tomography, and Society of Nuclear Medicine and Molecular Imaging, recently published a consensus document recommending best practices for the use of ionizing radiation in cardiovascular medicine. With the increase in number and complexity of catheter-based cardiovascular interventions, cardiothoracic anesthesiologists are being requested to consult and provide care for these patients. This review summarizes the salient portions of the consensus document as it pertains to the anesthesiologist. Radiation exposure for both patients and providers should be minimized to be as low as reasonably achievable. For the anesthesiologist involved in the procedure, the authors recommend wearing protective garments including apron, vest, neck collar, and glasses of at least 0.25-mm lead or lead equivalent. The addition of a portable shield also is strongly recommended. The anesthesiologist should maintain the maximum distance allowable from the x-ray source, remembering that radiation intensity is inversely proportional to the square of the distance from the x-ray source. Monitoring radiation exposure is done best by both collar and under-apron film badge. A 0.5-mm lead-equivalent apron is expected to shield approximately 95% of the radiation. By using these recommendations, the anesthesiologist should be able to keep radiation exposure under 20 mSv per year as recommended by the International Commission on Radiation Protection.
美国心脏病学会与美国核医学学会、心脏节律学会、修复心脏协会、北美心血管成像学会、心血管血管造影和介入学会、心血管计算机断层扫描学会以及核医学和分子成像学会合作，最近发布了一份共识文件，建议在心血管医学中使用电离辐射的最佳实践。随着基于导管的心血管介入数量和复杂性的增加，心胸麻醉师被要求为这些患者提供咨询和护理。这篇综述总结了共识文件中与麻醉师相关的重要部分。应尽量减少患者和医务人员的辐射暴露，使其达到合理可行的最低水平。对于参与手术的麻醉师，作者建议穿着防护服装，包括围裙、背心、颈套和至少 0.25 毫米的铅或铅当量眼镜。强烈建议添加便携式屏蔽。麻醉师应保持与 X 射线源的最大允许距离，记住辐射强度与距 X 射线源的距离的平方成反比。通过使用衣领和围裙下胶片徽章，最好对辐射暴露进行监测。预计 0.5 毫米铅当量的围裙可屏蔽约 95%的辐射。通过使用这些建议，麻醉师应能够将辐射暴露保持在每年 20 毫希沃特以下，这是国际辐射防护委员会建议的水平。
