Difference between revisions of "Upper GI endoscopy"
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=== 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. For patients with severe upper GI bleed or severe GERD who are at risk of aspiration, consider RSI with ETT to secure airway. | 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. | ||
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. --> === | ||
Revision as of 12:42, 19 November 2021
| Anesthesia type |
MAC vs. GA |
|---|---|
| Airway |
Natural airway |
| 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 |
|---|---|
| Neurologic | |
| Cardiovascular | |
| Respiratory | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Preoperative Hgb for patients with severe bleeding.
Operating room setup
- Nasal cannula
- Propofol drip
Patient preparation and premedication
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 for oxygenation.
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
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.
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