男子醫療中心照胃鏡亡

梗係啦....
但個醫生實牙實齒話冇野

類比錯喎 仲有醫療中心
唔算係醫院

照胃同腸唔係打鎮靜劑咩

公立醫院排幾耐先照到腸胃鏡？咁快排到2次？

因為醫生話我有胃潰瘍，先食一個月藥再照，第一次好辛苦，第二次就知道佢嘅程序就冇咁辛苦，其實佢醫院淨係上晝就可以做20個人，等就一個鐘，做就唔使10分鐘

俾我真係唔敢用
冇airway protection 出事上council唔知點解釋

Dormicum, fentanyl pethidine大把選擇
佢走去用propofol

即刻駁嘴?
柒撚到

其實醫院都有日間手術中心
去返醫院個d穩陣d

香港地d 護士真係得閒讀下書先衝出來俾意見
唔好成日只係識自己接觸到的做法，然後當做唯一真理

3個問題返去讀下書
1. 做胃鏡，Propofol 係咪唔用得？一定係 IV Benzodiazepine + opioid

2. 用propofol 係咪一定要有麻醉科醫生在場？定trained endoscopists/nurses 已經用得

3. 有心臟倒流 + 因鼻道狹窄接受過手術 + 曾患肺結核 係咪就唔屬於適合用 propofol 做鎮靜？

就件事來講，多一個考慮
相關醫生/護士 係咪接受過使用propofol的訓練 + 當時有無持續監測病人 + 具備緊急搶救的能力&藥物&設備

成件事就咁睇表面証據，都係已知風險的不幸情況

麻醉藥個part出事
仲要有隱性疾病
R.I.P.

應該好多日間中心都無麻醉科醫生
RIP

公立做過無麻醉嘅胃鏡
唔覺得辛苦
照嘅過程又快
衰在係太多病人排隊等超耐

做之前聽人講做到要生要死咁
最辛苦都係入口果下同打氣

其實開始同過程都唔辛苦
聽佢落口令數1、2、3 然後吞條鏡就OK

又係想R錢

唔認為呢單野告得入

非麻醉科醫生施行丙泊酚鎮靜
Non-anesthesiologist–administered propofol sedation (NAAP)

For unselected procedures and patients, three studies were found:
▶ A meta-analysis of 22 RCTs that compared propofol monotherapy versus traditional sedation (1798 patients) for GI endoscopy has been added to● " Table 1; it found shorter recovery and discharge periods, higher post-anesthesia recovery scores, better sedation, and greater patient cooperation with propofol monotherapy compared with traditional sedation, with no increase in cardiopulmonary complications [18]. The healthcare category of the provider of propofol sedation was not mentioned.
▶ Two prospective, multicenter, non-comparative, surveys from Germany that globally involved > 200 000 patients found a low incidence of propofol-related complications: one survey analyzed endoscopist-administered propofol sedation and reported major adverse events (mask ventilation and laryngospasm) in 0.016 % of patients [19]; in the other study, NAAP was used for sedation in > 90 % of cases, it reported clinically relevant sedation-related complications (defined as respiratory insufficiency that required mechanical ventilation and/or caused hospitalization or prolongation of hospital stay) in 0.042 % of patients and sedation-related death in 0.003 % (not 0.00042 % and 0.00003 % as miscalculated by the authors) [20].
For advanced endoscopic procedures, three meta-analyses were found:
▶ A meta-analysis of 26 prospective observational trials that compared propofol sedation administered by a non-anesthesia provider versus an anesthesia provider in > 5000 advanced endoscopic procedures (EUS, ERCP, and deep small-intestinal enteroscopy) [21]. NAAP was associated with similar safety but lower patient and endoscopist satisfaction compared with anesthesia provider-administered propofol sedation.
▶ Two meta-analyses compared propofol versus traditional sedation, either for advanced endoscopic procedures in general (9 RCTs, 969 patients) [22] or for ERCP alone (6 RCTs, 663 patients) [23]. Propofol was administered by a non-anesthesiologist in 7 of the 9 RCTs including advanced procedures and 3 of the 6 RCTs on ERCP. Both studies found that propofol sedation was associated with a shorter recovery time and a similar incidence of cardiopulmonary adverse events; additionally the largest study found that propofol was associated with a better sedation and amnesia level. The duration of ERCP was similar with propofol versus traditional sedation.

[Non-anesthesiologist administration of propofol for gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates
DOI http://dx.doi.org/ 10.1055/s-0034-1393414 Published online: 12.11.2015 Endoscopy 2015; 47: 1175– 1189es Guideline – Updated June 2015

日間醫療中

個西醫都系打工仔jar

在保險代理介紹下

Dormicum 係鎮定劑，
Fentanyl 同 pethidine 係止痛藥，
Propofol 係麻醉藥，唔同㗎。不過佢多俾咗藥個病人死咗就出事嗱。

咁人人都可以用propofol做鏡既
不過唔係anaes / icu 嘅
有幾多人夠經驗可以舞到哩隻藥
同埋如果bp/airway奶左野既佢地救唔教得返先

都有唔同嘅方嘅。仲有midazolam + fentanyl，當然有啲地方係可以照果個做埋靜脈麻醉。不過佢有冇跟足指引、佢果隊人有冇睇緊尐指素都好緊要。我都有個打左50mcg fentanyl就hyposic arrest 左。仲要係個麻醉師打嘅

我明你想表達咩...上面班傻鳩仲以為自己好撚醒
最穩陣一定入院照， 不過可能無保險貪平 快靚正就診所