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Anesthesia Outside the OR

Discussion in 'Anesthesiology' started by ProEra, Sep 7, 2014.

  1. ProEra

    ProEra ASA Member
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    Hey Guys,

    I'm working on a presentation regarding current trends in anesthetic management outside of the OR and wanted to reference guidelines that already exist. I've been looking on the ASA website and their statements regarding nonoperating room anesthesia, MAC, and propofol use are pretty weak.

    Are there any guidelines or recommendations out there from ASA or any other organizations? Or is this still a major grey area within the field? Thanks.
     
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  3. Noyac

    Noyac ASA Member
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    Moderate or Conscious sedation a protocols are a good place to start.
     
  4. BuzzPhreed

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    I would echo Noyac.

    Also with the recent happening in NYC with Joan Rivers I must admit that I'm a bit suspect of those coming onto this forum and asking for such information. It may be a bit of an over-reaction on my part, I know, but I'm sure a lot of Google hits will point to this forum where there is a plethora of medical students, residents, and practicing board-certified anesthesiologists discussing such matters. Someone who is a "medical student" with 8 posts who suddenly shows-up asking this kind of thing is maybe - just maybe - a blogger or journalist or, perish the thought, an attorney looking for ammo? None can be sure. (Reviewing your other posts, ProEra, I don't think you fit the bill.)

    Again, I would echo Noyac. And, I would only add: there is no gray area when you have a board-certified anesthesiologist at the head of the bed.
     
  5. ProEra

    ProEra ASA Member
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    Lol. Thanks. I was looking for how you guys decide which procedures require moderate or deep sedation. i.e. colonoscopy. And also, how you guys determine whether to use propofol/fentanyl vs midazolam/fentanyl vs ketamine/propofol/fentanyl vs remifentanil etc. But, I'll do some more looking for protocols. I guess this is where residency comes into play in terms of developing appropriate clinical judgement.
     
  6. IlDestriero

    IlDestriero Ether Man
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    I would bet much of the decision making comes from availability of drugs and equipment and the size and flow of the PACU. Nobody is getting a spinal in a 3 or 4 bed PACU for example. Remi is nice, but you have to mix it up, use a pump, etc. That's not a big deal, but it becomes one when you have 20 scopes on the schedule. One ASC I know has no morphine, only fentanyl. Quick on, reliable and the pt is out the door to home pain meds.
     

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