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{{Infobox surgical procedure
| anesthesia_type = MAC
| airway = Natural airway
| lines_access = 1 PIV (22 gauge)
| monitors = Standard ASA monitors
| considerations_preoperative = Watch for symptomatic anemia from GI bleed
| considerations_intraoperative =
| considerations_postoperative =
}}
 
A colonoscopy is a flexible scope that is inserted through the rectum to diagnose and treat problems with the lower GI tract (rectum, colon). It is commonly used to further work up patients with:
 
* Bright red blood per rectum (BRBPR)
* Melena
* Unexplained constipation/diarrhea
* Routine follow-up for patients with known polyps, IBD, other chronic bowel disease
* Colon cancer screening (in US, every 10 years after age 45)
 
== Preoperative management ==
 
=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Pulmonary
|
|-
|Gastrointestinal
|
|-
|Hematologic
|Anemia is common with lower GI bleed
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|Most patients are "dry" from bowel prep and tolerate a fluid bolus well during the procedure.
|}
 
=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
 
* CBC w/ Hgb
 
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
 
* Nasal cannula for oxygenation
*Have oral/nasal airway available
 
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
 
* Bowel prep based on GI physicians
 
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
 
* N/A
 
== Intraoperative management ==
 
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
 
* Standard ASA monitors
* 1 PIV
 
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
 
* Small amount of propofol and lidocaine (for MAC)
 
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
 
* Left lateral decubitus
 
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
 
* Propofol drip (TIVA)
 
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
 
* The Cecum is the turning point that determines the insertion and withdrawal phase of the colonoscope. When proceduralist states they have reached the cecum, the propofol drip can slowly be weaned down to time emergence.
 
== Postoperative management ==
 
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
 
* PACU and home unless unstable anemia
 
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
 
* This procedure is well tolerated and requires minimal/no pain management.
 
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
 
* Colonic Perforation
* Post-polypectomy bleeding
 
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
 
{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}
 
== References ==
 
[[Category:Surgical procedures]]

Latest revision as of 11:54, 19 August 2022

Colonoscopy
Anesthesia type

MAC

Airway

Natural airway

Lines and access

1 PIV (22 gauge)

Monitors

Standard ASA monitors

Primary anesthetic considerations
Preoperative

Watch for symptomatic anemia from GI bleed

Intraoperative
Postoperative
Article quality
Editor rating
Unrated
User likes
0

A colonoscopy is a flexible scope that is inserted through the rectum to diagnose and treat problems with the lower GI tract (rectum, colon). It is commonly used to further work up patients with:

  • Bright red blood per rectum (BRBPR)
  • Melena
  • Unexplained constipation/diarrhea
  • Routine follow-up for patients with known polyps, IBD, other chronic bowel disease
  • Colon cancer screening (in US, every 10 years after age 45)

Preoperative management

Patient evaluation

System Considerations
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic Anemia is common with lower GI bleed
Renal
Endocrine
Other Most patients are "dry" from bowel prep and tolerate a fluid bolus well during the procedure.

Labs and studies

  • CBC w/ Hgb

Operating room setup

  • Nasal cannula for oxygenation
  • Have oral/nasal airway available

Patient preparation and premedication

  • Bowel prep based on GI physicians

Regional and neuraxial techniques

  • N/A

Intraoperative management

Monitoring and access

  • Standard ASA monitors
  • 1 PIV

Induction and airway management

  • Small amount of propofol and lidocaine (for MAC)

Positioning

  • Left lateral decubitus

Maintenance and surgical considerations

  • Propofol drip (TIVA)

Emergence

  • The Cecum is the turning point that determines the insertion and withdrawal phase of the colonoscope. When proceduralist states they have reached the cecum, the propofol drip can slowly be weaned down to time emergence.

Postoperative management

Disposition

  • PACU and home unless unstable anemia

Pain management

  • This procedure is well tolerated and requires minimal/no pain management.

Potential complications

  • Colonic Perforation
  • Post-polypectomy bleeding

Procedure variants

Variant 1 Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References

Top contributors: Tony Wang, Charles Campana and Chris Rishel

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