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BACKGROUND: Most of endoscopic procedures, either diagnostic or therapeutic, are nowadays performed under sedation, used as a standard practice in most of the centers. Consequently, the number and complexity of endoscopic procedures has increased as sedation diminishes anxiety and discomfort for patients, also improving the quality of endoscopic examinations, and outcomes in therapeutic endoscopy. Compared to standard diagnostic upper or lower GI endoscopy, endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) are often longer and more complicated procedures, thus requiring higher doses of sedatives. Sedation levels and medication types depend on a variety of factors, related both to patient characteristics (age, comorbidities, preference, etc.), and procedure types (simple diagnostic endoscopy or more complex therapeutic procedures). Propofol has become undoubtedly the induction agent of choice as it is easy to administer, enables prompt awakening, and has fewer side effects. AIM: The aim of this paper is to outline the role and efficacy of the endoscopy nurse in the peri-procedural care of patients undergoing complex therapeutic interventions (EUS-guided and/or ERCP) under propofol sedation. METHODS: At our institution, the Research Centre of Gastroenterology and Hepatology Craiova, 192 patients underwent interventional endoscopic procedures between January 2014-December 2014 (130 EUS and 62 ERCP) under sedation with propofol. We included 110 patients in our study that were followed-up between 4 to 6 hours after the procedures. The GI nurse was responsible that the patients and/or their accompanying persons receive proper information in both written and spoken form regarding their procedure and potential adverse events after sedation. After the procedures the side effects related to anesthesia were marked down by the GI nurse based on a standard questionnaire. RESULTS: The patients mean age was 53.5 years old, with 46 (41.8%) women and 64 (58.2%) men. Most of the patients, that is 90 (81.8%), presented no adverse events. The other 20 patients (18.2%) had the following side effects from sedation: drowsiness in 5 (4.5%) of the cases, nausea in 3 cases (2.8%), vomiting in one case (0.9%), 2 (1.8%) of the patients presented dizziness, 2 (1.8%) headache, 3 (2.8%) coughing, only one patient (0.9%) had an injection site reaction, one (0.9%) had shivers, and 2 patients (1.8%) presented bradycardia. Patients that had side effects were mainly of advanced age and with associated diseases which included chronic kidney disease, cardio-vascular diseases. The nurse responsible with the follow-up of patients was able to rapidly assess their complaints and intervene to the benefit of the patient, before serious adverse events could occur. CONCLUSIONS: Although propofol sedations is generally considered safe, potential side effects should be held in mind. The GI nurse has a valuable role in monitoring patients and assessing their response to sedation after the procedure, as well as in timely stepping in where necessary to prevent further complications.
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PURPOSE: This qualitative study explored quality-of-life (QL) issues among Wisconsin's technology-dependent children and their families. METHODS: Five semi-structured focus groups were held with parents, siblings and health care workers of home-dwelling children dependent upon technology such as tracheostomy, ventilator support and gastrostomy tube feedings. Focus group transcripts were analyzed using an editing style format, with each author as an independent analyst. RESULTS: QL for the child was seen as a relative term, defined within the family, dependent upon the availability of services; and expressed in terms of physical comfort and function, and integration of the child into the family and community. Positive QL aspects for families include: growth as individuals, intrinsic rewards from the child and appreciation of others with handicaps. Negative impacts on family QL include: physical and mental anguish (e.g., exhaustion, suicidal ideation, back injuries), inhibitions of normal family functions, and isolation. Home nursing was highly valued despite lack of privacy. A number of ethical issues emerged including ineffective communication and lack of QL discussions during the child's acute treatment, end-of-life decisions, and potential cuts in Medicaid services. The latter issue prompted fear of poverty and divorce among siblings. CONCLUSIONS: Technology appears to exceed the sociological and ethical components of the care of these children, and QL is defined in terms of physical comfort, functional status, adequate services, and family/community integration. Parents assume an ambiguous medical role with their child, and need respite care and advocacy from their health care team.