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 hassle-free reference on all features of office-based anorectal surgical procedure for working towards basic surgeons and surgeons in education. Well-illustrated, this sensible handbook exhibits step by step methods for: - Hemorroidectomy - fix of anal fissures - maintenance of Fistula in-ano - Colonoscopy - Pilondial cyst. The textual content contains ancillary concerns of ambulatory surgical procedure with well timed chapters on set-up of the ability, anesthesic issues, choice of sufferers, pre-op and post-op administration, nursing features, and coding and billing. A needs to for all basic surgeons.
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Many patients fear the unknown procedure that lies ahead. In addition, it is important to verify that the procedure preparation was adequate. In the case of a colonoscopy, it is imperative that a bowel preparation be verified for the procedure to take place. Endoscopists use several different bowel preparations, and these are discussed later in the chapter. Staffing during the recovery phase should consist of an RN skilled in assessing the patient's return to his or her preprocedure baseline without untoward events.
Remifentanil is certainly one of the more flexible pharmacologic agents available for anorectal surgery. Alternatives to Narcotic Analgesia Minimizing patient discomfort in the postoperative period achieves both an early discharge and improved patient satisfaction. Preemptive analgesia has been discussed. Local infiltration is also a good, inexpensive, and effective method of pain control. Subfascial and intramuscular infiltration of local anesthetic is more potent than subcutaneous injection. Nonsteroidal anti-inflammatory medications, including ibuprofen and ketorolac (Toradol, Syntex International, Palo Alto, CA), are efficacious analgesics.
5 mg/kg. The duration of action is approximately 5 minutes after a bolus dose. The neuromuscular blocking action is terminated rapidly by the endogenous enzyme pseudocholinesterase. All of the nondepolarizing muscle relaxants currently in use are longer acting than succinylcholine and may require reversal for short 32 Fatima A. 4. Phannacokinetic properties of neuromuscular blocking agents. ' *Mivacurium is very short acting and the distribution half-life is insignificant. procedures. The disadvantage of reversal agents (neostigmine and atropine) is the high incidence of PONY.
Ambulatory Anorectal Surgery 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.)