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INTRODUCTION

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In most hospitals, the main arena for anesthesiologists is the operating room. However, with rapid growth in minimally invasive techniques, increased emphasis in diagnostic imaging, and procedure suites, anesthesia expertise is quickly growing outside the walls of the surgical suite.

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Unlike the operating room, remote locations are filled with potential hazards to providing safe anesthesia care.

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The American Society of Anesthesiologist (ASA) provides recommendations for all remote anesthesia sites. Some recommendations include two sources of oxygen, suction, scavenging for anesthetic gases, anesthesia machine, adequate lighting and power sources, in addition to standard ASA monitors and anesthesia equipment. This expertise should be brought to remote locations to assure anesthesia can be delivered safely and reliably.

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RISKS

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Space

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Space is a potential hazard for radiologic procedures. Space is potentially required for the following anesthesia equipment: the anesthesia cart, the anesthesia machine with appropriate gas inputs and medical outputs, such as suction and scavenging, the computer charting station, drug storage, and monitors. Due to limitations, equipment is frequently positioned atypically compared to the operating room (i.e., the anesthesia machine on the left rather than right side of the patient). The location of the patient relative to the anesthesiologist might also prove challenging. For example, in external beam radiation therapy rooms, because of radiation exposure, the anesthesiologist cannot be in the treatment room; consequently, patients are indirectly monitored through windows or cameras directed on the patient.

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Equipment

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A second potential hazard is the equipment. Monitors should be similar to the operating room. Well-maintained, standard monitor availability within an institution decreases the need for the anesthesiologist to orient to new devices. Monitors should comply with ASA standard monitoring requirements, including end-tidal carbon dioxide (ETCO2). Magnetic resonance imaging (MRI) suites provide unique problems with respect to equipment. The physiologic monitors must be MRI compatible. Also, the EKG reading may be distorted due to the magnetic field, making analysis of arrhythmias challenging.

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Other equipment, such as backup airway devices (i.e., laryngeal mask airways or oral and nasal airways), must be stocked nearby. Known difficult intubation cases may require induction of anesthesia in the operating room prior to transfer to a remote location. Malignant hyperthermia and code carts should be readily available and accessible.

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Communication

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In diagnostic radiology, the radiologist may not be readily available to discuss arising problems. The anesthesiologist must communicate effectively with unfamiliar personnel. Also, there must be a line of communication between remote anesthesiologists and the rest of the department for emergency support.

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Radiation

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There are three sources of radiation in the interventional radiology suite: (1) direct radiation from the X-ray tube; (2) leakage from the X-ray tube shielding; and (3) scattered radiation reflected from the patient. The amount of the radiation decreases ...

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