LSU Health Science Center, New Orleans.
Department of Anesthesiology, Louisiana State University Health New Orleans.
Pain Physician. 2019 May;22(3):201-207.
Many of the patients undergoing interventional procedures have daily regimens of medications including analgesics, muscle relaxants, and other drugs that can have significant additive/synergistic effects during the perioperative period. Further, many patients also present with comorbid states, including obesity, cardiovascular, and pulmonary disease. Consequently, in the perioperative period, a significant number of patients have suffered permanent neurologic injury, hypoxic brain injury, and even death as a result of over sedation, hypoventilation, and spinal cord injury. In addition, physicians are concerned about aspiration, subsequent complications, and as a result, they ask patients to fast for several hours prior to the procedures. Based on extensive literature and consensus, a minimum fasting period is established as 2 hours before a procedure for clear liquids and 4 hours before procedure for light meals, rather than having all patients fast for 8 hours or even fasting beginning at midnight the night before the procedure. Gastrointestinal stimulants, gastric acid secretion blockers, and antacids may be used, even though not routinely recommended. Due to the nature of chronic pain and anxiety, many patients undergoing interventional techniques may require mild to moderate sedation. Deep sedation and/or general anesthesia for most interventional procedures is considered as unsafe, since the patient cannot communicate acute changes in symptoms, thus, resulting in morbidity and mortality, as well as creating compliance issues. We are adapting the published standards of the American Society of Anesthesiologists for monitoring patients under sedation, regardless of the location of the procedure, either office-based, in a surgery center, or a hospital outpatient department. These standards include monitoring of blood pressure, cardiac rhythm, temperature, pulse oximetry, and continuous quantitative end tidal CO2 monitoring. Sedation must be provided either by qualified anesthesia or non-anesthesia providers, with appropriate understanding of the medications, drug interactions, and resuscitative protocols.KEY WORDS: Guidelines, sedation, fasting status, monitoring, neurological complications.
许多接受介入治疗的患者每天都要服用止痛药、肌肉松弛剂和其他药物，这些药物在围手术期可能会产生显著的相加/协同作用。此外，许多患者还伴有合并症，包括肥胖、心血管和肺部疾病。因此，在围手术期，大量患者因过度镇静、低通气和脊髓损伤而遭受永久性神经损伤、缺氧性脑损伤，甚至死亡。此外，医生还担心会发生误吸以及由此产生的并发症，因此，他们要求患者在手术前数小时禁食。基于广泛的文献和共识，确定了一个最短禁食时间，即手术前 2 小时可饮用清水，4 小时前可进清淡饮食，而不是让所有患者禁食 8 小时，甚至从前一天午夜开始禁食。尽管不常规推荐，但可以使用胃肠刺激剂、胃酸分泌抑制剂和抗酸剂。由于慢性疼痛和焦虑的性质，许多接受介入技术的患者可能需要轻度至中度镇静。对于大多数介入性手术，深度镇静和/或全身麻醉被认为是不安全的，因为患者无法在术中及时沟通急性症状变化，从而导致发病率和死亡率增加，同时也会产生合规问题。我们正在根据美国麻醉医师学会发布的标准来监测接受镇静的患者，无论手术地点是在门诊手术中心、医院还是在办公室，都要进行监测。这些标准包括监测血压、心律、体温、脉搏血氧饱和度和连续定量呼气末 CO2 监测。镇静必须由合格的麻醉师或非麻醉师提供，他们应充分了解药物、药物相互作用和复苏方案。
指南、镇静、禁食状态、监测、神经并发症。
