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An anesthesia service may be necessary for extensive endoscopic procedures, for endoscopic procedures that cannot be completed with attempted moderate or deep sedation or for patients with medical conditions that put them at highGuidelines to triage patients to conscious sedation (CS) or monitored anaesthesia care (MAC) for colonoscopy do not exist. We use the Anesthesia Care Team approach as we provide Anesthesia.Anesthesia services include monitored anesthesia care (MAC), regional anesthesia and general anesthesia. Challenges in Clinical ElectrocardiographyThe anesthetic of choice for endoscopic procedures is Monitored Anesthesia Care (MAC). The USPSTF (2017) found that completed trials of flexible sigmoidoscopy provide indirect evidence that colonoscopy - a similar endoscopic. Perforation of the colon and complications from anesthesia have been reported to occur in 0.1 to 0.3 of colonoscopies performed by gastroenterologists, and death occurs in 0.01 of colonoscopies. ![]() Anesthesia For Colonoscopy Drivers In The1This finding raises important questions, however. While our results demonstrate that MAC use did indeed increase in the VHA over the study period, the overall rate of MAC use in the VHA is substantially lower than that observed in fee-for-service environments, further supporting the existence of prominent financial drivers in the growing use outside the VHA. 1To better understand the extent to which increasing MAC use might be driven by financial incentives vs other factors, we assessed trends in MAC use in the Veterans Health Administration (VHA), an integrated health care delivery system with a capitated payment model.In this study, we sought to better characterize trends in MAC use in a non–fee-for-service environment in which financial incentives are largely absent. 4 Yet, more than half of MAC appears to be used for routine endoscopy in low-risk patients, suggesting widespread guideline-discordant use that may in part be driven by financial incentives. 3 Current guidelines recommend considering MAC for patients with anticipated intolerance of standard sedatives or certain comorbidities, but caution that MAC is not cost-effective for average-risk patients undergoing routine procedures.Doi: 10.1001/jamainternmed.2016.8566Author Contributions: Dr Adams had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.Study concept and design: Adams, Prenovost, Kerr, Krein, Rubenstein.Acquisition, analysis, or interpretation of data: Adams, Prenovost, Dominitz, Kerr, Saini, Rubenstein.Drafting of the manuscript: Adams, Prenovost.Critical revision of the manuscript for important intellectual content: Prenovost, Dominitz, Kerr, Krein, Saini, Rubenstein.Administrative, technical, or material support: Kerr.Conflict of Interest Disclosures: None reported.Funding/Support: Dr Adams was supported by National Institutes of Health 5 T32 DK 62708-12 during this research. Adams, MD, JD, MSc, Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 2215 Fuller Rd, Gastroenterology 111-D, Ann Arbor, MI 48105 ( Online: January 23, 2017. 6 Understanding the presence and degree of inappropriate use of MAC inside and outside the VHA will help promote efficient use of resources and ensure delivery of high-value care.Corresponding Author: Megan A. However, organizational factors influencing health care delivery, including practice culture, patient preference for MAC, 5 and increased availability of MAC in the VHA, may also contribute substantially to the increase in VHA MAC use.
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