Читать книгу Practical Pediatric Gastrointestinal Endoscopy - Группа авторов - Страница 41

At a minimum, the staff required for pediatric endoscopy with procedural sedation consists of four individuals. In addition to the gastroenterologist and endoscopy nurse, there must be an anesthesiologist (in case of general anesthesia or sedation provided by anesthesiologist) or another practitioner dedicated to monitoring the patient, whose sole responsibility is to continually observe and respond to the patient’s vital signs, physiologic status, and level of sedation. The practitioner should be skilled in assessment of cardiopulmonary function: respiratory rate and depth, early recognition of cyanosis, perfusion, and pulse assessment. Optimally, this individual would have a dedicated sedation nurse but this may not be possible at some institutions. Whether the sedation practitioner is a physician, physician assistant or nurse practitioner, they should be PALS certified and have adequate specialized training in pediatric procedural sedation and rescue techniques. Regular maintenance of these skills is recommended.

The majority of procedures are performed in endoscopy suites, which must be appropriately equipped to perform sedations safely. A crash cart or kit should include age‐ and size‐appropriate equipment and medications necessary to resuscitate a child. Airway equipment must include size‐appropriate BVM, airway delivery devices, and intubating equipment with age‐appropriate endotracheal tube sizes and laryngoscope blades. Cardiorespiratory monitoring should include electrocardiography, respiratory tracing, pulse oximetry, capnography, and noninvasive blood pressure monitoring with size‐appropriate cuffs. An oxygen source and suction with catheters must be available. A defibrillator, with pediatric paddles and adhesive pads, should be accessible. There should be a protocol for accessing a higher level of care such as a pediatric intensive care or step‐down unit, and in nonhospital environments, a system for accessing ambulance services.

Anesthesia apparatus is essential for procedures in general anesthesia. It may be situated in the endoscopy suite or the endoscopy team may perform procedures in the operating theatre with a mobile endoscopic device.