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Procedural Patient Management
Keith B. Quencer, MD
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KEY FACTS

  • Preprocedure Work-up

    • Informed Consent

      • Sedation

        • Time Out

          Preprocedure Work-Up

          • Review History, Labs, and Medications

            • Cardiac Risk Stratification

              • Contrast-Induced Nephropathy Risk Stratification

                • Preprocedure Management of Diabetic Patient

                  • Preprocedure Performance Status

                    • Informed Consent

                      • Exceptions to Informed Consent

                        Sedation

                        • Level of Sedation

                          • Moderate Sedation

                            • Presedation Checklist

                              Universal Protocol

                              • Brief

                                • Rationale, History

                                  • Time Out

                                    • Debrief

                                      Iodinated Contrast Reactions

                                      • Prophylaxis Regimens

                                        • Treatment of Reactions

                                          • CO₂ Contrast

                                            Monitoring

                                            • Intraprocedural Monitoring

                                              • Postprocedure Monitoring/Discharge

                                                Selected References

                                                1. Peng Y et al: Child-Pugh Versus MELD Score for the Assessment of Prognosis in Liver Cirrhosis: A Systematic Review and Meta-Analysis of Observational Studies. Medicine (Baltimore). 95(8):e2877, 2016
                                                2. Rafiei P et al: Society of Interventional Radiology IR Pre-Procedure Patient Safety Checklist by the Safety and Health Committee. J Vasc Interv Radiol. 27(5):695-9, 2016
                                                3. Cho KJ: Carbon Dioxide Angiography: Scientific Principles and Practice. Vasc Specialist Int. 31(3):67-80, 2015
                                                4. Wichmann JL et al: Contrast-Induced Nephropathy. Circulation. 132(20):1931-6, 2015
                                                5. Olsen JW et al: Moderate sedation: what radiologists need to know. AJR Am J Roentgenol. 201(5):941-6, 2013
                                                6. Kadoi Y: Perioperative considerations in diabetic patients. Curr Diabetes Rev. 6(4):236-46, 2010
                                                7. Papaspyros SC et al: Briefing and debriefing in the cardiac operating room. Analysis of impact on theatre team attitude and patient safety. Interact Cardiovasc Thorac Surg. 10(1):43-7, 2010
                                                8. Wiggins TF et al: Sedation, analgesia, and monitoring. Clin Colon Rectal Surg. 23(1):14-20, 2010
                                                9. ACR Manual on Contrast Media. Version 7, 2010
                                                10. Hawkins IF et al: Carbon dioxide in angiography to reduce the risk of contrast-induced nephropathy. Radiol Clin North Am. 47(5):813-25, v-vi, 2009
                                                11. Lasser EC: Nonionic iodinated contrast media reactions. AJR Am J Roentgenol. 192(2):W80; author reply W81, 2009
                                                12. Stahel et al: The 5th anniversary of the "Universal Protocol": pitfalls and pearls. Patient Safety in Surgery 3:14. 2009.
                                                13. Singh J et al: Iodinated contrast media and their adverse reactions. J Nucl Med Technol. 36(2):69-74; quiz 76-7, 2008
                                                14. Ead H: From Aldrete to PADSS: Reviewing discharge criteria after ambulatory surgery. J Perianesth Nurs. 21(4):259-67, 2006
                                                15. Bettmann MA: Frequently asked questions: iodinated contrast agents. Radiographics. 24 Suppl 1:S3-10, 2004
                                                16. Michota FA et al: The preoperative evaluation: use the history and physical rather than routine testing. Cleve Clin J Med. 71(1):63-70, 2004
                                                17. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists: Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 96(4):1004-17, 2002
                                                18. A follow-up review of wrong site surgery. Sentinel Event Alert. (24):1-3, 2001
                                                19. Cassileth BR et al: Informed consent -- why are its goals imperfectly realized? N Engl J Med. 302(16):896-900, 1980
                                                20. Faden RR et al: Decision-making and informed consent: a study of the impact of disclosed information. Soc Indic Res. 7(1-4):313-36, 1980
                                                Related Anatomy
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Preprocedure Work-up

                                                  • Informed Consent

                                                    • Sedation

                                                      • Time Out

                                                        Preprocedure Work-Up

                                                        • Review History, Labs, and Medications

                                                          • Cardiac Risk Stratification

                                                            • Contrast-Induced Nephropathy Risk Stratification

                                                              • Preprocedure Management of Diabetic Patient

                                                                • Preprocedure Performance Status

                                                                  • Informed Consent

                                                                    • Exceptions to Informed Consent

                                                                      Sedation

                                                                      • Level of Sedation

                                                                        • Moderate Sedation

                                                                          • Presedation Checklist

                                                                            Universal Protocol

                                                                            • Brief

                                                                              • Rationale, History

                                                                                • Time Out

                                                                                  • Debrief

                                                                                    Iodinated Contrast Reactions

                                                                                    • Prophylaxis Regimens

                                                                                      • Treatment of Reactions

                                                                                        • CO₂ Contrast

                                                                                          Monitoring

                                                                                          • Intraprocedural Monitoring

                                                                                            • Postprocedure Monitoring/Discharge

                                                                                              Selected References

                                                                                              1. Peng Y et al: Child-Pugh Versus MELD Score for the Assessment of Prognosis in Liver Cirrhosis: A Systematic Review and Meta-Analysis of Observational Studies. Medicine (Baltimore). 95(8):e2877, 2016
                                                                                              2. Rafiei P et al: Society of Interventional Radiology IR Pre-Procedure Patient Safety Checklist by the Safety and Health Committee. J Vasc Interv Radiol. 27(5):695-9, 2016
                                                                                              3. Cho KJ: Carbon Dioxide Angiography: Scientific Principles and Practice. Vasc Specialist Int. 31(3):67-80, 2015
                                                                                              4. Wichmann JL et al: Contrast-Induced Nephropathy. Circulation. 132(20):1931-6, 2015
                                                                                              5. Olsen JW et al: Moderate sedation: what radiologists need to know. AJR Am J Roentgenol. 201(5):941-6, 2013
                                                                                              6. Kadoi Y: Perioperative considerations in diabetic patients. Curr Diabetes Rev. 6(4):236-46, 2010
                                                                                              7. Papaspyros SC et al: Briefing and debriefing in the cardiac operating room. Analysis of impact on theatre team attitude and patient safety. Interact Cardiovasc Thorac Surg. 10(1):43-7, 2010
                                                                                              8. Wiggins TF et al: Sedation, analgesia, and monitoring. Clin Colon Rectal Surg. 23(1):14-20, 2010
                                                                                              9. ACR Manual on Contrast Media. Version 7, 2010
                                                                                              10. Hawkins IF et al: Carbon dioxide in angiography to reduce the risk of contrast-induced nephropathy. Radiol Clin North Am. 47(5):813-25, v-vi, 2009
                                                                                              11. Lasser EC: Nonionic iodinated contrast media reactions. AJR Am J Roentgenol. 192(2):W80; author reply W81, 2009
                                                                                              12. Stahel et al: The 5th anniversary of the "Universal Protocol": pitfalls and pearls. Patient Safety in Surgery 3:14. 2009.
                                                                                              13. Singh J et al: Iodinated contrast media and their adverse reactions. J Nucl Med Technol. 36(2):69-74; quiz 76-7, 2008
                                                                                              14. Ead H: From Aldrete to PADSS: Reviewing discharge criteria after ambulatory surgery. J Perianesth Nurs. 21(4):259-67, 2006
                                                                                              15. Bettmann MA: Frequently asked questions: iodinated contrast agents. Radiographics. 24 Suppl 1:S3-10, 2004
                                                                                              16. Michota FA et al: The preoperative evaluation: use the history and physical rather than routine testing. Cleve Clin J Med. 71(1):63-70, 2004
                                                                                              17. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists: Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 96(4):1004-17, 2002
                                                                                              18. A follow-up review of wrong site surgery. Sentinel Event Alert. (24):1-3, 2001
                                                                                              19. Cassileth BR et al: Informed consent -- why are its goals imperfectly realized? N Engl J Med. 302(16):896-900, 1980
                                                                                              20. Faden RR et al: Decision-making and informed consent: a study of the impact of disclosed information. Soc Indic Res. 7(1-4):313-36, 1980