Ambulatory Anorectal Surgery by Michael Lavan R.N., Judy Swanson R.N., Andrea Ferrara M.D.

By Michael Lavan R.N., Judy Swanson R.N., Andrea Ferrara M.D. (auth.), H. Randolph Bailey M.D., Michael J. Snyder M.D. (eds.)

Ambulatory Anorectal Surgery is a simple reference on all facets of office-based anorectal surgical procedure for training common surgeons and surgeons in education. Well-illustrated, this functional handbook indicates step by step strategies for: - Hemorroidectomy - fix of anal fissures - upkeep of Fistula in-ano - Colonoscopy - Pilondial cyst. The textual content comprises ancillary issues of ambulatory surgical procedure with well timed chapters on set-up of the ability, anesthesic concerns, choice of sufferers, pre-op and post-op administration, nursing facets, and coding and billing. A needs to for all basic surgeons.

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Each preparation has its own advantages and disadvantages. Susanna Hudson Setup and Procedure It is the responsibility of the endoscopy technician or assistant to prepare the room for the procedure. The patient's privacy can be maintained by simply turning the operative part away from the door. An occupied/unoccupied sign on the outside of the door will further deter unwanted traffic into the room during the procedure. As the technician arranges the room, he or she must allow enough space to assist the physician and still get to the supplies that might be needed during the examination.

The arrhythmogenic threshold for injected epinephrine is between that of enflurane and isoflurane. 57 iLg/kg. 17 iLg/kg. Currently, sevoflurane is used as both an induction and a maintenance agent. This is economical, because the high concentration required at the start of the procedure replaces the cost of propofo\. In the maintenance phase, less sevoflurane is required because the desired alveolar concentration has already been reached in the induction phase. Additionally, sevoflurane provides ideal conditions for intubation and precludes the need for muscle relaxants.

Sevoflurane, initially suspect for its nephrotoxicity, fell out of favor until recently, and it is now beginning to gain in popularity for outpatient surgery. Choice of Narcotics Fentanyl has stood the test of time and is the most commonly used narcotic in outpatient anesthesia. It is important to administer fentanyl 2 to 5 minutes before the propofol so that the dose of propofol can be minimized and the maximal analgesic effect will be present during surgical and anesthesia stimulation. 0 f-Lglkg is given at the beginning of the anesthetic to avoid a delay in awakening.

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