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 uncomplicated reference on all facets of office-based anorectal surgical procedure for practising common surgeons and surgeons in education. Well-illustrated, this functional handbook indicates step by step techniques for: - Hemorroidectomy - fix of anal fissures - maintenance of Fistula in-ano - Colonoscopy - Pilondial cyst. The textual content comprises ancillary concerns 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 points, and coding and billing. A needs to for all basic surgeons.
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Extra resources for Ambulatory Anorectal Surgery
Most regulating agencies agree on the definition of conscious sedation as providing a minimally reduced level of consciousness in which the patient retains the ability to maintain an airway independently and to respond appropriately to physical stimulation and/or verbal command. The goals of conscious sedation are to decrease the patient's anxiety and elevate the pain threshold to ensure cooperation from the patient while providing some degree of amnesia. The agents used in conscious sedation are commonly a benzodiazapine (usually midazolam or diazepam) in combination with a narcotic agent (such as fentanyl or meperidine) administered intravenously (by the physician or by the RN under the direction of the physician) and titrated to achieve the desired response from the patient.
In addition to the viewing capabilities of the flexible endoscope, there is an air-water system inside the scope allowing for controlled insufflation of room air into the colon. Water is available primarily to keep the viewing lens at the distal tip washed clean of debris and to minimize fogging. A larger working channel is built in for suctioning liquid effluent and introducing accessories. The working channel is of varying size depending on the type of scope selected. Different devices are available to perform a variety of tasks that may be necessary during even a routine examination.
Of course, the medical history of the patient must be reviewed by the medical professionals for them to be aware of conditions, such as narrow-angle glaucoma, myasthenia gravis, or prostatic hypertrophy, that might contraindicate the use of anticholinergics. Glucagon can also be given to decrease gastrointestinal motility and relax the colon. In many instances, the timely use of one of these agents may markedly improve the patient's tolerance of the procedure. The nurse must know each of these drugs and their potential benefit.
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