PERSONNEL
Nonanesthesia personnel involved in patient care in non-operating
room anesthetizing locations, including circulating nurses and radiology technicians,
are frequently less familiar with the management of patients under anesthesia than
are their counterparts who care for patients in the operating suite. Consequently,
they are frequently not able to provide the skilled assistance that anesthesia personnel
may take for granted in other areas. Open communication between care teams is essential,
especially because skilled assistance for the anesthesia care team may be some distance
away. Thus, the presence of an adequate number of anesthesia personnel in the immediate
vicinity of the care site is vital. Educational programs for personnel in non-operating
room anesthetizing locations may be helpful in this regard.
Many procedures in non-operating room anesthetizing locations
may be performed with conscious sedation provided by practitioners not specialized
in anesthesiology. The ASA has published "Practice Guidelines for Sedation and Anesthesia
by Non-Anesthesiologists."[6]
Numerous recommendations
are provided. The patient must be evaluated before the procedure by qualified personnel
to ensure that patients are not compromised by coexisting medical conditions, are
appropriately fasting, and have given informed consent. During the procedure, the
level of consciousness, ventilation, oxygenation, and hemodynamics are to be monitored.
The standard monitoring practice discussed earlier should be used. A designated
individual, not the individual performing the procedure, should be present to monitor
the patient and ensure maintenance of an adequate level of sedation and analgesia.
This designated individual should be trained to
recognize complications of analgesia and sedation, and at least one individual trained
in basic life support skills should be present continuously when moderate or deep
sedation is used. Supplemental oxygen should be used for moderate and deep sedation,
and emergency equipment, including pharmacologic antagonists, should be available.
Defibrillators should be available for at-risk patients undergoing moderate sedation
and for all patients undergoing deep sedation. Adequate recovery care should be
provided, with the patient observed in an adequately staffed and equipped recovery
area. The patient should be released only when acceptable discharge criteria have
been met.
Timely provision of anesthesia personnel for patients who either
require deeper levels of anesthesia or are determined to be at higher risk because
of an underlying condition aids in efficient operation of the location where the
anesthetic care is to be delivered. However, dispatch of these anesthesia personnel
may hinder efficient operation of the anesthesia department elsewhere. Organization
of the anesthesia department to provide services both within and outside the operating
suite is key to efficient provision of patient care. Specific recommendations for
such organization are extremely dependent on the health care system under consideration.
Non-operating room anesthetic locations with predictable utilization might best
benefit from either full- or part-time staffing by anesthesia personnel. Areas with
less predictable utilization may be more efficiently staffed in an "on-call" fashion
by the anesthesia department, with a clear understanding by the personnel primarily
staffing that area of the mechanisms for obtaining anesthetic services. Some institutions
have benefited by the institution of an "anesthesia sedation service," which may
be a mechanism for providing anesthesia services to multiple areas with less predictable
utilization.[7]
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