Difference between revisions of "Upper GI endoscopy"
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = MAC vs. GA | | anesthesia_type = MAC vs. GA | ||
| airway = Natural airway | | airway = Natural airway w/ bite block | ||
| lines_access = 1 PIV | | lines_access = 1 PIV | ||
| monitors = Standard ASA | | monitors = Standard ASA | ||
| Line 25: | Line 25: | ||
!System | !System | ||
!Considerations | !Considerations | ||
|- | |||
|Airway | |||
|Especially important to assess risk of patient obstructing upon induction when GA with natural airway or MAC is the anesthetic plan. | |||
|- | |- | ||
|Neurologic | |Neurologic | ||
| Line 32: | Line 35: | ||
| | | | ||
|- | |- | ||
| | |Pulmonary | ||
| | |Review risk factors for OSA i.e STOP BANG | ||
|- | |- | ||
|Gastrointestinal | |Gastrointestinal | ||
| Line 39: | Line 42: | ||
|- | |- | ||
|Hematologic | |Hematologic | ||
| | |Patients may be acutely anemic from upper gi bleed, assess appropriateness of transfusing PRBC prior to procedure | ||
|- | |- | ||
|Renal | |Renal | ||
| Line 56: | Line 59: | ||
=== 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 | * Nasal cannula/POM mask | ||
*Bite Block | |||
* Propofol drip | * Propofol drip | ||
*Prepare to manage airway if severe hypoxemia develop, with ability to provide positive pressure ventilation with 100% oxygen. | |||
*Succinylcholine for treatment of laryngospasm | |||
=== 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. -->=== | ||
Consider using an antisialagogue such as glycopyrrolate for patients considered high risk for increased secretions. | |||
=== 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 | 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 | * Standard ASA monitors | ||
* 1 PIV | *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. -->=== | ||
GA w/ natural airway vs MAC sedation. The insertion of the scope itself can be quite stimulating, and many patients may not be able to tolerate this with MAC sedation. Use nasal cannula for oxygenation. | GA w/ natural airway vs MAC sedation. The insertion of the scope itself can be quite stimulating, and many patients may not be able to tolerate this with MAC sedation. Use nasal cannula or POM mask for oxygenation. Nasal CPAP or High flow oxygen may be appropriate for patients at high risk of obstructing and becoming hypoxemic. | ||
For patients with severe upper GI bleed or severe GERD who are at risk of aspiration, consider RSI with ETT to secure airway. | For patients with severe upper GI bleed or severe GERD who are at risk of aspiration, consider RSI with ETT to secure airway. | ||
=== 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. -->=== | ||
Generally left lateral decubitus | Generally 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 | *Propofol drip | ||
*Intermittent boluses of propofol may be used in shorter duration cases | |||
*A fentanyl push prior to scope insertion (25 mcg) can help minimize coughing | |||
*The patient being able to tolerate a jaw thrust prior to scope insertion can help determine if patient is deep enough if procedure done under MAC | |||
=== 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. -->=== | ||
== 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. -->=== | ||
To PACU and generally safe discharge to home/floor within hours. | To PACU and generally safe discharge to home/floor within hours. | ||
=== 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. -->=== | ||
Minimal pain | Minimal pain | ||
=== 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. -->=== | ||
Patients can be high aspiration risk if there is severe upper GI bleed or severe GERD. | Patients can be high aspiration risk if there is severe upper GI bleed or severe GERD. | ||
== 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). --> == | Hypoxemia | ||
==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" | {| class="wikitable wikitable-horizontal-scroll" | ||
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|} | |} | ||
== References == | ==References== | ||
[[Category:Surgical procedures]] | [[Category:Surgical procedures]] | ||
Latest revision as of 12:15, 19 August 2022
Upper GI endoscopy
| Anesthesia type |
MAC vs. GA |
|---|---|
| Airway |
Natural airway w/ bite block |
| Lines and access |
1 PIV |
| Monitors |
Standard ASA |
| Primary anesthetic considerations | |
| Preoperative |
GERD, unstable airway from upper GI bleed |
| Intraoperative |
Aspiration risk |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
An upper GI endoscopy (or EGD) is a procedure where a flexible scope is inserted through the mouth to diagnose and treat problems with the upper GI tract (esophagus, stomach, duodenum). It is commonly used to further work up patients with:
- upper GI bleed
- severe GERD
- dysphagia
- intractable vomiting
- non-cardiac chest/abdominal pain
- unexplained weight loss
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | Especially important to assess risk of patient obstructing upon induction when GA with natural airway or MAC is the anesthetic plan. |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | Review risk factors for OSA i.e STOP BANG |
| Gastrointestinal | |
| Hematologic | Patients may be acutely anemic from upper gi bleed, assess appropriateness of transfusing PRBC prior to procedure |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Preoperative Hgb for patients with severe bleeding.
Operating room setup
- Nasal cannula/POM mask
- Bite Block
- Propofol drip
- Prepare to manage airway if severe hypoxemia develop, with ability to provide positive pressure ventilation with 100% oxygen.
- Succinylcholine for treatment of laryngospasm
Patient preparation and premedication
Consider using an antisialagogue such as glycopyrrolate for patients considered high risk for increased secretions.
Regional and neuraxial techniques
N/A
Intraoperative management
Monitoring and access
- Standard ASA monitors
- 1 PIV
Induction and airway management
GA w/ natural airway vs MAC sedation. The insertion of the scope itself can be quite stimulating, and many patients may not be able to tolerate this with MAC sedation. Use nasal cannula or POM mask for oxygenation. Nasal CPAP or High flow oxygen may be appropriate for patients at high risk of obstructing and becoming hypoxemic.
For patients with severe upper GI bleed or severe GERD who are at risk of aspiration, consider RSI with ETT to secure airway.
Positioning
Generally left lateral decubitus
Maintenance and surgical considerations
- Propofol drip
- Intermittent boluses of propofol may be used in shorter duration cases
- A fentanyl push prior to scope insertion (25 mcg) can help minimize coughing
- The patient being able to tolerate a jaw thrust prior to scope insertion can help determine if patient is deep enough if procedure done under MAC
Emergence
Postoperative management
Disposition
To PACU and generally safe discharge to home/floor within hours.
Pain management
Minimal pain
Potential complications
Patients can be high aspiration risk if there is severe upper GI bleed or severe GERD.
Hypoxemia
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Tony Wang, Adam Harari, Charles Campana and Chris Rishel