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Anaesthesia in remote locations

Anaesthesia in remote locations. Includes: gastroscopy, colonoscopy, ERCP, hearing tests, interventional radiology, MRI and CT scans, etc Often outside theatre – consulting rooms, XR dept’s, etc Still needs to be safe for the patient. 4 Aspects to consider:. 1. The facility:

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Anaesthesia in remote locations

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  1. Anaesthesia in remote locations Includes: gastroscopy, colonoscopy, ERCP, hearing tests, interventional radiology, MRI and CT scans, etc Often outside theatre – consulting rooms, XR dept’s, etc Still needs to be safe for the patient

  2. 4 Aspects to consider: 1. The facility: • Standard equipment necessary: O2 source and reserve, suction, monitoring, ambu bag, resuscitation equipment (drugs, defibrillator) communication method to call for help • Problems related to a specific venue: 1. MRI: small area, difficult access to pt, no ferromagnetic equipment, noise pollution 2. Radiology: radiation pollution, small area, difficult access to pt, dark (don’t see disconnections)

  3. Needs of the surgeon: • Pt needs to lie still • Pt sometimes prone – sedation difficult (airway Mx) • Manipulation of blood pressure (e.g. when stent = deployed) • Pause in respiration (e.g. when stent = deployed)

  4. Factors related to the pt: • Some pt can’t lie still (Parkinson’s, orthopnoea, GORD) – consider GA as opposed to sedation • Contrast related side effects (iodine allergy, renal failure)

  5. Anaesthetic considerations • Often day case surgery (use short-acting drugs) • Check availability of reversal drugs for sedation agents (Naloxone, Flumazinil) • Options for sedation: Benzodiazepines, opiates, propofol, ketamine, chloral hydrate, dexmedetomidine • Options for administration: IV bolus, TIVA, TCI

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