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Anesthetic Considerations For Endoscopic Procedures (Pre-Op, Intra-Op, Post-Op)

This document discusses anesthetic considerations for endoscopic procedures including pre-op, intra-op, and post-op care. It outlines the types of endoscopic procedures performed, pre-procedure preparation including fasting guidelines and assessments. It then details different anesthetic techniques that can be used including monitored anesthesia care, sedation, total intravenous anesthesia and general anesthesia. Common anesthetic medications, monitoring practices, airway management techniques, and potential problems that can occur in the post-procedure period are summarized.

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201 views27 pages

Anesthetic Considerations For Endoscopic Procedures (Pre-Op, Intra-Op, Post-Op)

This document discusses anesthetic considerations for endoscopic procedures including pre-op, intra-op, and post-op care. It outlines the types of endoscopic procedures performed, pre-procedure preparation including fasting guidelines and assessments. It then details different anesthetic techniques that can be used including monitored anesthesia care, sedation, total intravenous anesthesia and general anesthesia. Common anesthetic medications, monitoring practices, airway management techniques, and potential problems that can occur in the post-procedure period are summarized.

Uploaded by

Zieg BadKarma
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Anesthetic Considerations for

Endoscopic Procedures
(Pre-op, Intra-op, Post-op)
Ziegfried L. Loo Tian, R.M.T., M.D., D.P.B.A.
Anesthesia
• Loss of sensation with or without loss of
consciousness
• Artificially induced insensitivity to pain
• To render a patient pain free, enabling them to
tolerate a certain procedure
Endoscopy
Endoscopic Procedures
EGD

Colonoscopy

EUS

Sigmoidoscopy

ERCP

Enteroscopy

PEG Tube Insertion


Pre-Procedure
Pre-procedure considerations

1 2
Airway
Solids: 6 or 8 hours
Co-morbidities
Clear Liquids: 2 or 3 hours
Allergies
NPO
Maintenance Medications

Pre-procedure Assessment Pre-procedure Fasting


Procedure Proper
Anesthetic Technique
• MAC - Monitored Anesthesia Care
• MAC with sedation - Monitored Anesthesia
Care wtih sedation (benzodiazepines, opioids)
• TIVA - Total IntraVenous Anesthesia
(barbiturates, propofol)
• GA - General Anesthesia (volatile anesthetics)
Anesthetic Medications
• Benzodiazepines • Fentanyl
– Hypnotic – Opioid analgesic
– Sedative – Exhibits synnergism with
– Amnesic (anterograde) benzodiazepines
– Anti-epileptic • Respiratory depression
– Spinal cord mediated • Abuse potential
skeletal muscle relaxation • Onset: 6 - 7 minutes
• Respiratory depression • Duration: 30 - 60 minutes
• Fatigue and drowsiness
• Abuse Potential
• Midazolam (1-3/ 30-80)
• Diazepam (1 / 60-120)
• Lorazepam (5-10/ 120-
360)
• Alprazolam (PO only)
Anesthetic Medications
• Barbiturates • Propofol
– Thiopental – Hypnotic sedative
– Hypnotic sedative – Can be used even in cirrhotic
– Neuroprotective patients
• Respiratory depression – 30 minutes
• Cardiac depression – Anti-emetic
• Pain on injection • Respiratory
• Onset: 30 - 45 seconds depression/apnea
• Duration: 5 - 10 minutes • Cardiac depression
• Allergies
• Abuse potential
• Pain on injection
• Onset: 15 - 30 seconds
• Duration of action: 5 - 10
minutes
Anesthetic Medications
Volatile anesthetic for GA
• Anesthesia machine
• Sevoflurane
• Sevoflurane vaporizer
• Anesthesia breathing
circuit and mask
• Oxygen
Emergency Medications
• Vasopressors/Inotropes
– Ephedrine
– Phenylephrine
– Dopamine
– Epinephrine
– Dobutamine
– Norepinephrine
• Atropine
Monitoring
• Standard I
– Qualified anesthesia
personnel
• Standard II
– Oxygenation
– Ventilation
– Circulation
– Temperature
Airway Management

Nasal cannula (with or without opening the airway)

Nasopharyngeal airway (NPA)

Endoscopy mask

Supraglottic airway
Airway Mangement – Nasal Cannula
Airway Mangement – Nasopharyngeal
Airway (NPA)
Airway Management – Endoscopy
Mask
Opening the Airway
Head tilt & chin lift Jaw thrust
Bag Mask Ventilation
1 man vs. 2 man E-C Clamp Technique
E-V Clamp
Airway Management – Supraglottic
Airways
Gastro Laryngeal Tube LMA Gastro
Anesthetic Requirements
Choice of anesthetic is largely operator
dependent
• Topical/local anesthetics
• Benzodiazepines (midazolam/diazepam)
• Opioids (fentanyl/meperidine)
• Benzodiazepine+opioid
• Barbiturates/Propofol
• Inhalational
Common Problems
• Hypotension
• Airway obstruction
• Respiratory depression
Post-Procedure
Post Procedure
• PACU (Standard I) • Hypotension
– Cardiac monitor for each • Nausea/vomiting
bed
– Oxygen supply
• Dizziness
• Accompanied by anesthesia • Pain
team member (Standard II) • Hypothermia
• Proper handoff (Standard III)
• Continually evaluated by
qualified nursing personnel
(Standard IV)
• Discharge by physician
(Standard V)
Thank you

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