How to prepare patients for endoscopic procedures

Published on 09/04/2015 by admin

Filed under Gastroenterology and Hepatology

Last modified 09/04/2015

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Chapter 28 HOW TO PREPARE PATIENTS FOR ENDOSCOPIC PROCEDURES

KEY POINTS

Correct patient preparation involves:

ASSESSMENT OF PATIENT FITNESS FOR PROCEDURE

Health professionals assessing patients for endoscopy should be aware of the American Society of Anesthesiologists (ASA) classification of patient risk (see Table 28.1). The degree of concern will be dictated somewhat by the level of anaesthetic support available for the procedure (which ranges between institutions from none to an anaesthesiologist, as well as varying for different types of procedures). In general, procedures on ASA class I and most class II patients can be safely performed in a well equipped endoscopy suite with appropriately trained staff. ASA class III patients might be better triaged to the operating room. This degree of patient risk must be identified prior to the endoscopy list so that appropriate patient assessment (and informed consent) can be undertaken as well as ensuring that the procedure is performed in the appropriate environment.

Table 28.1 Definition of American Society for Anesthesiologists comorbidity status

Class 1 Patient has no organic, physiologic, biochemical or psychiatric disturbance. The pathologic process for which the operation is to be performed is localised and does not entail systemic disturbance
Class 2 Mild to moderate systemic disturbance caused by either the condition to be treated surgically or by other pathophysiologic processes
Class 3 Severe systemic disturbance or disease from whatever cause, even though it may not be possible to define the degree of disability with finality
Class 4 Severe systemic disorders that are life-threatening, not always correctable by operation
Class 5 The moribund patient who has little chance of survival but is submitted to the operation in desperation

PROCEDURE-SPECIFIC ISSUES