Anesthesia experiences outside of the operating room

Introduction And Aim: Thanks to technological developments, invasive and non-invasive diagnostic and therapeutic procedures have been done at the outside of the operating room. In this manner, to provide anesthesia at the outside of the operating room, anesthesia teams have been found. In this study, we aimed to report our anesthesia teams’ experiences.
Materials And Methods: We reviewed the procedures that was experienced at outside the operating room from October 2010 to April 2012 retrospectively. 3583 Patients who required anesthesia at the outside of the operating room included the study, and their sexes, ages, ASA status, procedures, and anesthesia complications were recorded.
Results: Patients’ sex ratio male/female 1671/1912; ranged in age from 20 day to 91 years; with the mean age 48,52±28,4. ASA status were, ASA I 1958, ASA II 1296, ASA III 318, ASA IV 11. Anesthesia procedures were for 1837 colonoscopy, 536 gastroscopy, 131 ERCP endoscopic retrograde cholangiopancreatography, 811 MRI magnetic resonance imaging, 62 CTI computerized tomography imaging, 234 ECT electroconvulsive therapy, 106 RT radiotherapy, 40 angiographic aneurysm embolization, 9 angiographic venous sampling, 43 carotis stent, and 63 other radiologic interventions. For sedation; 1960 Patient received propofol + alfentanil, 740 only propofol, 544 propofol + fentanyl, 115 ketofol, 65 midazolam+ketamin 83 dexmedetomidine. For electroconvulsive therapies, 90 patient received etomidate + succinyl choline, 144 propofol + succinyl choline. 40 patient received general anesthesia for embolisation procedures. There are no major complication occured except one patient experienced intracranial hemorrhage during colonoscopy. In minor complications; 12 patient experienced respiratory depression, 41 bradycardia, 144 oxygen desaturaion, 191 prolonged recovery from anesthesia, 8 vomiting.
Conclusion: Anesthesia procedures at the outside of the operating room are frequently used in all medical interventions and at all ages. Remote locations from operating room, inadequate equipment and monitors,not enough space in the working environment, providing anesthesia outside the operating room is challenging and requires expertise and skill. The secret of success in anesthesia in remote locations is the skilled anesthesiologist with the appropriate equipment and drugs, along with adequate backup facilities. Anesthesia procedures at the outside of the operating room are guarding the patients safety and welfare, minimising physical discomfort and pain, providing physicians’ comfort.

Ameliyathane dýþý anestezi deneyimlerimiz

Giriþ ve Amaç: Teknolojik geliþmeler sayesinde, hastalara taný ve tedavi amacýyla ameliyathane dýþý ortamlarda invaziv ve non-invaziv uygulamalara baþlanmýþtýr. Bu durum ameliyathane dýþý anestezi (ADA) ekiplerinin kurulmasýna neden olmuþtur. Biz, bu çalýþmada, ADA ekibimizin deneyimlerini sunmayý amaçladýk.
Gereç ve Yöntem: Ekim 2010-Nisan 2012 tarihleri arasýndaki ADA uygulamalarýmýzý retrospektif inceledik. ADA uyguladýðýmýz 3583 olgunun cinsiyeti, yaþý, ASA’sý, yapýlan giriþimleri, uygulanan anestezi ilaçlarý ve komplikasyonlarý kaydedildi.
Bulgular: Olgularýn cinsiyet daðýlýmý E/K 1671/1912, yaþ ortalamalarý 48.52±28.4, yaþ daðýlýmý 20 günlük - 91 yaþ arasýndaydý. ASA sýnýflamasý ASA I 1958, ASA II 1296, ASA III 318, ASA IV 11 þeklindeydi. 1837 olguya kolonoskopi, 536 olguya gastroskopi, 131 olguya ERCP uygulandý. 811 olguya MR, 62 olguya BT çekimi yapýldý. 234 seans EKT uygulamasý, 106 seans RT uygulamasý yapýldý. Anjiografi ünitesinde 40 olguya anevrizma embolizasyonu uygulandý. Anjiografi ünitesinde 9 olguya venöz sampling, 43 olguya karotis stent uygulamasý yapýldý. Ayrýca 63 olguya giriþimsel radyolojide farklý uygulamalar yapýldý. Olgularýn 1960’ýnda propofol+alfentanil,740’ýnde propofol, 544’ünde propofol+fentanil, 115’inde ketofol, 65’inde midozolam+ketamin, 83’ünde dexmetedomidin sedasyonu uygulandý. 234 EKT seansýnýn 90’ýnda etomidate+süksinilkolin, 144’ünde propofol+süksinilkolin uygulandý. 40 embolizasyon olgusuna genel anestezi
verildi. Geçirilmiþ serebrovasküler hastalýk, hipertansiyon öyküsü olan olguda kolonoskopi iþlemi esnasýnda intrakraniyal kanama geliþmesi dýþýnda majör bir komplikasyonla karþýlaþýlmadý. 12 olguda solunum depresyonu, 41 olguda bradikardi, 144 olguda desatürasyon, 19 olguda derlenme süresinin uzamasý, 8 olguda kusma gibi minör komplikasyonlarla karþýlaþýldý.
Sonuç: ADA uygulamalarý her alanda ve her yaþ grubunda sýklýkla kullanýlan bir yöntemdir. Ameliyathaneden uzak olma, yetersiz donaným ve monitör, çalýþma alanýndaki hareket kýsýtlýlýðý ADA uygulamalarýný zorlayýcý kýlmakta, beceri ve deneyim gerektirmektedir. Uygun donaným, ilaçlar ve yeterli koþullarda deneyimli bir anestezist ADA uygulamalarýndaki baþarýnýn sýrrýdýr. Ameliyathane dýþý anestezi uygulamalarý hasta güvenliðini ve memnuniyetini artýrýp, huzursuzluk ve aðrýyý azaltmakta, hekim konforunu arttýrmaktadýr.