A painless gastroscopy informed consent form should be signed before surgery. For those who are elderly or suffer from

cardiovascular, respiratory, endocrine, liver and kidney diseases, they should be strictly screened and < /p>

Targeted preparation. The contraindications for routine gastroscopy are also the contraindications for painless gastroscopy

[[2]. It is also inappropriate to perform painless gastroscopy under the following circumstances: ① Diseases that are likely to

cause suffocation, such as excessive phlegm, vinegar retention in the stomach, and large amounts of blood in the stomach; ②

Those with a heart rate below 50 beats/min; ③Severe Those who suffer from adultery and excessive obesity; ④ Pregnant women and lactating women; ⑤ Those who are allergic to the drugs used.

In short, with the help of anesthesia technology, gastroscopy can greatly reduce or It eliminates the physical and psychological pain of patients during the examination and makes it easier for doctors to operate. It is worthy of promotion and can be applied to other endoscopic examinations.

(14) Electronic gastroscopy appointment notice

Name___________ (outpatient clinic, ward _________department______room)

Examination appointment date:_______year____ From _____ to _____ hours on the morning of _month____

Please read the "Information Form" carefully and choose one of them to sign

Electronic gastroscopy

< p> Electronic gastroscopy has been proven to be highly safe after many years of clinical practice and wide application, but the following complications may also occur: (1) cardio-cerebral and pulmonary vascular accidents; (2) severe bleeding; (3) Digestive tract perforation; (4) throat abrasion; (5) infection; (6) complications such as non-penetrating pneumoperitoneum. The incidence rate of general complications is less than 1‰.

Conscious sedation electronics Gastroscopy (commonly known as: painless electronic gastroscopy)

"Conscious sedation electronic gastroscopy" uses one or more drugs to make the patient calm and non-anxious, which can reduce the pain during general electronic gastroscopy , is popular among patients and is widely used, and has been proven to be highly safe. However, in addition to the above-mentioned complications of electronic colonoscopy, there may also be complications such as: (1) respiratory depression; (2) cardiac arrest and other complications. Symptoms. The complication rate is less than 0.5‰.

I have read the above information in detail, and the medical staff’s explanations are clear and understandable. After careful consideration, I agree to undergo the __________________ examination.

Patient signature:

Family signature:

Notes:

1. No food (including medications) from 8:00 pm the day before the examination to before the examination ), those with dry mouth can drink a small amount of boiled water.

2. The elderly and infirm need to be accompanied by one person during "painless electronic gastroscopy".

3. Those who do not make the above preparations, No examination will be performed.

4. A certain fee is required after the "painless electronic gastroscopy" is completed, which is not included in the application form.

5. The examination is completed for patients with local anesthesia of the throat. You need to wait one hour before eating, and those who have pathological biopsy need to wait three hours before eating.

6. You are not allowed to drive or drink alcohol within 12 hours after having a "painless electronic gastroscopy."

7. Please come for examination on time. If there are special circumstances and the examination cannot be carried out on the appointment date, the appointment examination date must be changed 2 days in advance to arrange examinations for other patients. Expiration will be invalid.