Buscopan, Xylocaine

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????????

• ???????
• ?????

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????????

• ????????
• ?????,???, ??,??
• ???????
• Buscopan, Xylocaine
• conscious sedation, anesthesiologist
• ?????????
• ??
• ???
• ??

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?? (Contra-indication)

• ??????????
• ?????????
• ??????????????
• ??????????????????????
• ?????????????

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??

• ??????????, ????
• ?????
• ?????
• ???
• ??????
• ?????????
• ?????????

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???????

1. ?????
2. ??????????
3. ?????????
4. ??????
5. ????
6. ??????????
7. ??????

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???????--?????--

• ????????????????
• ???Indications????
• ????
• ???X????
• ???????
• ???????
• ???????
• ??-????screening
• ????????????????,????(abuse)?????contraindications
  ??

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???????--?????--

• ?????????????,?????
• ???????
• ?????informed consent
• ???????????????????,??????,????????

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???????--??????????--

• A.NPO
• B.Colon preparation
• C.???,?????
• D.????
• E.????

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???????--?????????--

• A.?????
• B.?????????
• C.????X??
• D.Premedication-Buscopan
• -Gascon
• -Xylocain
• -Demerol
• E.?????????????????
• Vital signs, monitoring (BP,PR,RR,O2,CO2)
  Oximeter
• F.????.O2,Suction,IV drugsNaloxone, Flumazenil

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???????--??????--

• A.??complete
• B.????duration
• C.???????SOP??
• D.???Biopsy
• E.?????
• F.??????
• G.????

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???????--???????????????--

• Post- endoscopy care
• ????????
• ?????
• ????????
• ??????????????
• ?????,???????????

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???????--?????????
EGD Dx Overall rate 0.13
Mortality rate 0.004
cardiopulmonary(46)
sedation / analgesia
Colonoscopy Dx Overall rate 0.35
Perforation 0.2
Bleeding 0.09
Polypectomy Overall rate 2.3
Perforation 0.32
Bleeding 1.7
?(ASGE 1974) JAMA 1976 ?(ASGE 1974) JAMA 1976 ?(ASGE 1974) JAMA 1976
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???information??????

• Before
• (1) ??
• (2) ??
• (3) ????????
• ???????/???????
• ?????????,???????
• ????????????

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???

• (1) ?????
• (2) ????????????????
• (3) ?????Biopsy ???????
• (4) ????????????????

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???????????????????

• ?????????
• ????????
• ??manual???
• ??????????????

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????????????

• ??????
• ?????
• ?????
• ?????
• ???????????????

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???????????

• ???????,??indications, risk factors
• ??????anxiety,??Good colon preparation
• ??????????
• ?????vital signs
• ?weak?
• BP?
• ?anemic
• ?Dyspenic
• Unconscious
• ??????????,??procedureSOP
• ??????bleeding tendency(??Aspirin)
• Post endoscopy care (platelet?)
• ?????????(coagulation disorders)
• ?????
• Scope???

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????

• ??(?)
• ????30???????????????????????
• ???????????????,???????????????,???????0.1??,????
  ???????
• ?????????????????,???????????

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????

• ??(?)
• ??????????,?????,????
• ????????,?????????,?????
• ??????????,????,??????

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???????
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Premedication for Endoscopy-- Basic Require--

• UGI study
• ??
• Gascon (Dimethicone)
• Buscopan (Hyscine Butylbromide), Demerol
• 10 Xylocaine spray
• 2 xylocaine gel

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Premedication for Endoscopy in Pediatric

• Pediatrics
• Ketamine Domicum
• Buscopan Demerol

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???????

• (1) ?????? (opiate analgesics)
  ?? ??????
• Meperidine (demerol) 1-2
  mg/kg IV,max 100 mg 5-10 min
• Fentanyl
  1-2 mg/kg IV,max 4 mg/kg 1-5 min
• ????????
• Alfentanil, sufentanil, ramifentanil (
  ????????????? )
• (2) Benzodiazepaines
• Diazepam
  0.1-0.3 mg/kg IV 5-10 min
• Midazolam (Dormicum) 0.035-0.07
  mg/kg every 2-3 min 5 min
• 
  Max dose 6 mg ( 0.5-6 y/o )
  
• 
  10mg ( gt5 y/o )
• (3) ????
• ??????????--NSAID
• Ketorolac
  60mg IM
• (?????????????????? )
  ???????
• Propofol (2,6-diisoprophylphenol, Diprivan)
  0.75-1.0 mg/kg
• (???????????????? )

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???

• ??????????????????????????????????????,????????
  ????(synergistic effects),???????,?????.

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?????? Antagonists

• ??
  ??????
• Opioid antagonist
• Naloxone 0.1 mg/kg IV or
  IM 2-5 min
• 
  (?????,????)
• Benzodiazepine
• antagonist
• Flumazenil 0.01 mg/kg IV
  1-2 min
• (imidazobenzodiazepine? ?? )
• 
  (?????,????)

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???????????

• 1.????
• Aminophylline, Digoxin, Isoptine,
• Isuprel, Xylocaine
• 2.????
• Bosmine, Dopamine, Dobutamine
• Levophed, Xylocaine
• 3.??????
• Ca-gluconate, Solu-cortef, Solu-medrol
• Sodium Bicarbonate, Vena 

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????????? -????
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Esophagus
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Lower Esophageal Sphincter
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Stomach
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Stomach
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Duodenal Bulb
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Descending Duodenum
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2nd portion of duodenum
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Reverse view in stomach
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Cardia and Fundus
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?????????(????)
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A normal perineal and rectal examination
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Endoscopic view of the ileocecal valve
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Endoscopic view of the orifice of the appendix.
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Insertion into the terminal ileum by hooking and
withdrawal
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