Читать книгу Leksell Radiosurgery - Группа авторов - Страница 102

The patient arrives for treatment at 05:30 and the nursing team greets them in the Gamma Knife waiting area. Every effort will be made to have the nurse who saw the patient preoperatively take care of the patient on the day of treatment. An IV is inserted. The IV is necessary for intraoperative sedation as well as contrast medium for imaging studies. Emla cream (lidocaine and prilocaine) is applied to the patient’s forehead over the area where the pins will be placed. This will numb the skin and make the local injection more tolerable. All female patients of child-bearing age will have a urine test for pregnancy prior to the start of the Gamma Knife treatment. Patient monitoring will include blood pressure, pulse oximetry, and EKG. Patients receiving IV conscious sedation are started on 2 L of O₂ via the nasal cannula. Patients initially receive 1 mg of Lorazepam sublingually. To prepare the patient for the frame application, they are placed in a sitting position on a stretcher. Sterile towels are draped over the patient’s shoulders. The Emla cream is now removed. The patient’s head is cleaned with 70% alcohol, paying particular attention to the back of the head and the forehead. Frame-based patients will also receive carefully titrated doses of intravenous fentanyl and midazolam prior to the placement of the stereotactic frame. Nurses administering the IV sedation must have ACLS certification. The patient is monitored closely following IV sedation.