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Anesthesiologist-managed sedation for endoscopic retrograde cholangiopancreatography: Experience at the University of Hong Kong Shenzhen Hospital
Providing sedation and analgesia to patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) is challenging because of patient position, procedure duration, and depth of sedation required. Conventionally, sedation for ERCP is managed by endoscopists with intravenously administered benzodiazepines and opioids. With increasing complexity of ERCP procedures, there is a trend to involve anesthesiologists to provide sedation and anesthesia. Anesthesiologists are able to provide general anesthesia in failed sedation. (Source: Techniques in Gastrointestinal Endoscopy)
Source: Techniques in Gastrointestinal Endoscopy - March 18, 2016 Category: Gastroenterology Authors: Vivian M. Yuen, Heng F. Xia, Yau W. Chan, Xia Yan, Michael G. Irwin Source Type: research

Operational Considerations for Delivery of Anesthesia in the Ambulatory GI Suite
As the need for Anesthesiology Services expands beyond the operating room (OR) to Gastroenterology venues, collaborative practice standards become increasingly necessary. Goal alignment is critical in order to assure patient safety, comfort and optimized outcomes. Anesthesia standards of care and the normal cadence of running a GI suite must achieve integration on both an operational and medical level. This becomes more difficult as procedural and patient complexity increase. Significant challenges discussed here include costs and format of preoperative assessment, mutually acceptable scheduling platforms, limitations of n...
Source: Techniques in Gastrointestinal Endoscopy - March 9, 2016 Category: Gastroenterology Authors: Wendy L. Gross Source Type: research

Operational considerations for delivery of anesthesia in the ambulatory gastrointestinal suite
As the need for Anesthesiology Services expands beyond the operating room to Gastroenterology venues, collaborative practice standards become increasingly necessary. Goal alignment is critical to assure patient safety, comfort, and optimized outcomes. Anesthesia standards of care and the normal cadence of running a gastrointestinal suite must achieve integration on both an operational and medical level. This becomes more difficult as procedural and patient complexity increase. Significant challenges discussed here include costs and format of preoperative assessment, mutually acceptable scheduling platforms, limitations of ...
Source: Techniques in Gastrointestinal Endoscopy - March 8, 2016 Category: Gastroenterology Authors: Wendy L. Gross Source Type: research

Sleep disordered breathing and the endoscopy patient: Considerations for Optimization of periprocedural care
A significant proportion of patients undergoing ambulatory procedures are at risk for sleep disordered breathing (SDB). Obstructive sleep apnea is the most common diagnosis but other types such as opioid related central apnea are important variants. Long-term cardiovascular, neurologic, and related sequelae of untreated SDB are significant such that screening at-risk patients with low-tech bedside tools such as STOP-BANG is warranted. Patients with presumptive SDB should be educated about the disease and referred for specialty evaluation and formal diagnosis. (Source: Techniques in Gastrointestinal Endoscopy)
Source: Techniques in Gastrointestinal Endoscopy - March 7, 2016 Category: Gastroenterology Authors: Joshua H. Atkins Source Type: research

Sleep-disordered breathing and the patient undergoing endoscopy: Considerations for optimization of periprocedural care
A significant proportion of patients undergoing ambulatory procedures is at risk for sleep-disordered breathing (SDB). Obstructive sleep apnea is the most common diagnosis, but other types such as opioid-related central apnea are important variants. Long-term cardiovascular, neurologic, and related sequelae of untreated SDB are significant such that screening at-risk patients with low-tech bedside tools such as STOP-BANG is warranted. Patients with presumptive SDB should be educated about the disease and referred for specialty evaluation and formal diagnosis. (Source: Techniques in Gastrointestinal Endoscopy)
Source: Techniques in Gastrointestinal Endoscopy - March 6, 2016 Category: Gastroenterology Authors: Joshua H. Atkins Source Type: research

Perspectives on anesthetic management for ERCP and interventional GI procedures: The case for the natural airway
The current trend for the relocation of complex patients undergoing complex procedures outside the traditional Operating Room Suite is exemplified by the breadth and growth of advanced interventional endoscopy procedures available within the modern GI endoscopy suite. A new anesthesia subspecialty, NORA (Non–Operating Room Anesthesia) has been born in response to the increasing demands for anesthesia and sedation services in GI suites, interventional radiology and cardiology. Accordingly a new multidisciplinary medical society has been founded: SONORIA (Society of Non-OR Interventionalists and Anesthesiologists). (Source...
Source: Techniques in Gastrointestinal Endoscopy - March 4, 2016 Category: Gastroenterology Authors: Jeffrey D.F. White Source Type: research

Perspectives on anesthetic management for endoscopic retrograde cholangiopancreatography and interventional gastrointestinal endoscopy procedures: The case for the natural airway
The current trend for the relocation of complex patients undergoing complex procedures outside the traditional operating room (OR) suite is exemplified by the breadth and growth of advanced interventional endoscopy procedures available within the modern gastrointestinal (GI) endoscopy suite. A new anesthesia subspecialty, non-OR anesthesia has been born in response to the increasing demands for anesthesia and sedation services in GI suites, interventional radiology, and cardiology. Accordingly, a new multidisciplinary medical society has been founded —Society of Non-OR Interventionalists and Anesthesiologists. (Source: T...
Source: Techniques in Gastrointestinal Endoscopy - March 3, 2016 Category: Gastroenterology Authors: Jeffrey D.F. White Source Type: research

Perspectives on anesthetic management for endoscopic retrograde cholangiopancreatography and interventional gastrointestinal endoscopy procedures: The case for the natural airway
The current trend for the relocation of complex patients undergoing complex procedures outside the traditional operating room (OR) suite is exemplified by the breadth and growth of advanced interventional endoscopy procedures available within the modern gastrointestinal (GI) endoscopy suite. A new anesthesia subspecialty, non-OR anesthesia has been born in response to the increasing demands for anesthesia and sedation services in GI suites, interventional radiology, and cardiology. Accordingly, a new multidisciplinary medical society has been founded—Society of Non-OR Interventionalists and Anesthesiologists. (Source: Te...
Source: Techniques in Gastrointestinal Endoscopy - March 3, 2016 Category: Gastroenterology Authors: Jeffrey D.F. White Source Type: research

Preface
Gastrointestinal endoscopy has evolved rapidly from a limited array of primarily diagnostic procedures to a highly advanced, technically sophisticated, and procedurally challenging field with numerous therapeutic applications. In concert with these developments has been the increased need and demand for anesthesia services to facilitate longer, move invasive procedures. The aggressive push by payers and health systems alike to optimize resource utilization, efficiency, and outpatient therapy has been particularly acute in non-operating room procedural suites. (Source: Techniques in Gastrointestinal Endoscopy)
Source: Techniques in Gastrointestinal Endoscopy - February 21, 2016 Category: Gastroenterology Authors: Joshua H. Atkins Source Type: research

Preface
Gastrointestinal endoscopy has evolved rapidly from a limited array of primarily diagnostic procedures to a highly advanced, technically sophisticated, and procedurally challenging field with numerous therapeutic applications. In concert with these developments has been the increased need and demand for anesthesia services to facilitate longer, more invasive procedures. The aggressive push by payers and health systems alike to optimize resource utilization, efficiency, and outpatient therapy has been particularly acute in non –operating room procedural suites. (Source: Techniques in Gastrointestinal Endoscopy)
Source: Techniques in Gastrointestinal Endoscopy - February 20, 2016 Category: Gastroenterology Authors: Joshua H. Atkins Source Type: research

“New Horizons for sedation: The ultrashort acting benzodiazepine Remimazolam”
Procedural sedation is used in 98% of endoscopies performed in the US. The predominant agents used are benzodiazepines, opioids and propofol. The optimal sedation depends on the procedure being performed and its duration. An ideal sedative would allow for flexible, rapid onset and offset of sedation with predictable short duration of action with minimal cardiopulmonary risk factors. Remimazolam is a novel “soft drug” with the characteristics of a benzodiazepine and organ-independent metabolism.Remimazolam binds selectively and with high affinity to the GABAA receptor, with no off-target activities. (Source: Techniques ...
Source: Techniques in Gastrointestinal Endoscopy - February 17, 2016 Category: Gastroenterology Authors: D.J. Pambianco, B.D. Cash Source Type: research

New horizons for sedation: The ultrashort acting benzodiazepine remimazolam
Procedural sedation is used in 98% of endoscopies performed in the United States. The predominant agents used are benzodiazepines, opioids, and propofol. The optimal sedation depends on the procedure being performed and its duration. An ideal sedative would allow for flexible, rapid onset and offset of sedation with predictable short duration of action with minimal cardiopulmonary risk factors. Remimazolam is a novel “soft drug” with the characteristics of a benzodiazepine and organ-independent metabolism. (Source: Techniques in Gastrointestinal Endoscopy)
Source: Techniques in Gastrointestinal Endoscopy - February 16, 2016 Category: Gastroenterology Authors: Daniel J. Pambianco, Brooks D. Cash Source Type: research