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INTRODUCTION AND OUTLINE OF THE THESIS
INTRODUCTION
The demand for monitored anaesthesia care (MAC) for diagnostic and therapeutic
procedures outside the operating room (OR) increases continuously. A multitude of
medical specialists, e.g. gastroenterologists, interventional cardiologists or radiologists,
gynaecologists, dentists, and even psychiatrists ask for safe, but efficient anaesthesia
support for more and more complex procedures. Today, also patients are more assertive
and no longer willing to undergo painful or stressful situations without an adequate form
of sedation or anaesthesia.
Therefore, anaesthesia departments have to recognise that it is necessary to move out
of the OR comfort zone even if this means thinking outside the own box. It is known
that procedures outside the OR have the potential to be more challenging than those
performed in the OR: procedure settings and locations outside the OR very often do not
have the standard of anaesthesia care that anaesthesia caregivers are accustomed to. In
addition, the form of anaesthesia often varies from conscious to deep sedation or even
general anaesthesia in patients often having a lot of comorbidities.
That means criteria that have to be considered for procedures under sedation outside the
OR include a long list of variables that concern procedure, location, patient, and anaesthesia
provider himself.
Hereby it is important to assess invasiveness, complexity and length of the procedure,
the amount and severity of possible complications, and the level of sedation or analgesia
needed to perform the procedure. It is also necessary to check anaesthesia requirements on
location and post procedure recovery facilities carefully.
As themost important point, anaesthesia providers have to evaluate patient`s characteristics
and comorbidities precisely as well as in form and content requirements on sedation
providers themselves.
Given these requirements, a multidisciplinary cooperation of all key players in a hospital
institution is necessary to determine the appropriate standards and hospital guidelines
to provide optimal conditions for the procedure and the patient at affordable conditions.
These standards should accordingly be evaluated based on their achieved outcomes in
patient´s safety, the satisfaction of all parties - patient, anaesthesia provider and procedure
operator - and the finally gained efficiency.
The new field of procedural sedation outside the OR belongs to the core functions of the
anaesthesiologist, but besides the fact that this would be extremely cost intensive, there
is a lack of manpower within the anaesthesia departments to meet the steadily increasing
demand. Therefore, a discussion about the qualifications needed to provide safe and
efficient sedation and the need for non-anaesthesiologists (non-physicians) taking over this
task was pre-programmed.