Difference between revisions of "Colonoscopy"
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = MAC | ||
| airway = | | airway = Natural airway | ||
| lines_access = | | lines_access = 1 PIV (22 gauge) | ||
| monitors = | | monitors = Standard ASA monitors | ||
| considerations_preoperative = | | considerations_preoperative = Watch for symptomatic anemia from GI bleed | ||
| considerations_intraoperative = | | considerations_intraoperative = | ||
| considerations_postoperative = | | considerations_postoperative = | ||
| Line 13: | Line 13: | ||
* Bright red blood per rectum (BRBPR) | * Bright red blood per rectum (BRBPR) | ||
* Melena | * 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) | * Colon cancer screening (in US, every 10 years after age 45) | ||
| Line 30: | Line 31: | ||
| | | | ||
|- | |- | ||
| | |Pulmonary | ||
| | | | ||
|- | |- | ||
| Line 37: | Line 38: | ||
|- | |- | ||
|Hematologic | |Hematologic | ||
| | |Anemia is common with lower GI bleed | ||
|- | |- | ||
|Renal | |Renal | ||
| Line 46: | Line 47: | ||
|- | |- | ||
|Other | |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. --> === | === 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. --> === | === 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. --> === | === 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. --> === | === 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 == | == 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. --> === | === 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. --> === | === 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. --> === | === 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. --> === | === 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. --> === | === 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 == | == Postoperative management == | ||
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> === | === 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. --> === | === 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. --> === | === 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). --> == | == 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). --> == | ||
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 | |
| 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