Colonoscopy

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
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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