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16
Chapter 1
acupuncture with acupuncture needles. Sham acupuncture thereby means that verum-
acupuncture needles were placed 1 cm lateral and distal to the acupuncture points used
in the EA group. Group PA received sham-acupuncture with placebo-needles (Streitberger
needles) on the points also used in the SA group to exclude an effect of acupressure on the
classic acupuncture points. Primary endpoint was defined as the total dosage of propofol.
As secondary objective we determined satisfaction of patients and endoscopists measured
by questionnaires.
Part 3
In this part of the thesis we focus on adverse events related to procedural sedation outside
the OR. The overall number of sedation related incidents is relatively low, but their impact
can be enormously since adverse events ascribed to moderate and deep sedation levels are
frequently affiliated with the cardiorespiratory system.
39,40,41
It is known that cardiorespiratory
complications account for the greatest part of sedation-related morbidity and mortality.
Chapter 13
discusses the case of an anaphylactic shock during percutaneous evacuation
of an ecchinococcus cyst. This procedure is usually performed under deep sedation outside
the OR with a multidisciplinary team consisting of a sedation specialist, a radiologist, and a
radiology technician. Every team member has his own expert field, but they are most often
not trained to work as a team in a critical situation. An anaphylactic shock is such a critical
situation. Although anaphylactic reactions during this procedure are rare (1.7%), they carry a
mortality rate of 0.03%
42
and ask for fast resolutions. We want to show with this case report
that cognitive aids can help to solve this problem.
The final
chapter 14
presents our own data from a nationwide prospective registration
of complications during various procedure types with deep sedation performed by
anaesthesia nurse practitioners in 24 Dutch hospitals from the 1
st
February 2015 to 1
st
March
2016. Hospitals were both, academic and district general hospitals. For this registry, we
translated and modified the adverse event reporting tool from the International Sedation
Task Force of theWorld Society of Intravenous Anaesthesia.
43
We provided anaesthesia nurse
practitioners with the possibility to fill in a paper copy of the tool or an electronic online
version. We also collected patient age, ASA physical classification, medical history, method
of preassessment, type of procedure, National Confidential Enquiry into Patient Outcome
and Death (NCEPOD) classification of the procedure, attendance of an anaesthesiologist,
and drugs used.