Anesthesia for gastrointestinal endoscopy in adults
- Basavana Goudra, MD, FRCA, FCARCSI
Basavana Goudra, MD, FRCA, FCARCSI
- Associate Professor of Anesthesiology and Critical Care Medicine
- Perelman School of Medicine Hospital of the University of Pennsylvania
There has been a rapid increase in the number and complexity of gastrointestinal (GI) endoscopic procedures performed during the last decade . Anesthesiologists may be asked to provide anesthesia for procedures that require sedation or general anesthesia, or to provide monitoring with or without sedation for patients with significant comorbidities. The complexity of endoscopic procedures has increased, and advanced endoscopic procedures are often performed as alternatives to open surgery for medically complicated patients.
This topic will discuss anesthetic management for gastrointestinal endoscopy. Management of monitored anesthesia care, office based anesthesia, and procedural sedation and alternatives to sedation administered by non-anesthesia clinicians are discussed separately. (See "Monitored anesthesia care in adults" and "Overview of procedural sedation for gastrointestinal endoscopy" and "Alternatives and adjuncts to moderate procedural sedation for gastrointestinal endoscopy" and "Sedation-free gastrointestinal endoscopy" and "Office-based anesthesia".)
A medical history and anesthesia-directed physical examination should be performed for all patients who undergo any type of anesthesia, including sedation for endoscopy. The goals for preanesthesia evaluation are to identify underlying medical and physical conditions that may increase risk and to create an anesthetic plan that minimizes risk.
In anticipation of gastrointestinal endoscopy, the patient should be evaluated for conditions that increase sensitivity to sedative and analgesic medications (eg, older age; obstructive sleep apnea; advanced chronic lung disease; pulmonary hypertension; coronary artery, liver, or renal disease; anxiety disorders; chronic pain; use of opioids, sedatives, or recreational drugs) to allow appropriate drug dosing and administration. (See "Overview of procedural sedation for gastrointestinal endoscopy", section on 'Patient-related considerations'.)
●ASA physical status — Similar to other procedures that require anesthesia, patients with higher American Society of Anesthesiologists (ASA) physical status (table 1) classification are at increased risk of periprocedural adverse events [2,3]. The complexity and application of advanced endoscopic procedures are increasing, as well as the comorbidities of the patients who undergo these procedures. In particular, therapeutic endoscopic retrograde cholangiopancreatography (ERCP) is associated with increased risk of adverse events, regardless of ASA status , and is now performed for patients who were previously considered inoperable or who are critically ill.
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- PREPROCEDURE EVALUATION
- PREOPERATIVE FASTING
- ANESTHETIC MANAGEMENT
- Choice of anesthetic technique
- Airway management
- Anesthetic requirements for endoscopic procedures
- - Diagnostic endoscopy
- - Colonoscopy
- - Advanced endoscopic procedures
- Choice of drugs for sedation/analgesia
- - Topical local anesthetic
- - Propofol
- - Midazolam
- - Opioids
- - Dexmedetomidine
- - Ketamine
- POSTANESTHESIA CARE
- SUMMARY AND RECOMMENDATIONS