Upper GI endoscopy
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
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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
Pulmonary
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