Anesthesia Considerations in Endoscopy

Christy Johnson, MSNA, CRNA

Nurse Anesthetist

Hanover Anesthesia Group

Memorial Regional Medical Center

Objectives

● The participant will be able to verbalize how anesthesia became involved in Endoscopy

● The participant will be able to recognize a possible “complicated” patient

● The participant will be able to identify an obstructed airway and simple corrective measures

History

● In office based procedures sedation was provided by RN

● Increased co-morbidity brought more cases into the hospital setting

● Use of Propofol increased the speed of procedure and recovery

● Gastroenterologist comfort level increased with Anesthesia in charge of the airway

●

ASA Physical Status Classifcation

● ASA 1 : A normal healthy patient● ASA 2 : Patient with mild systemic disease● ASA 3 : Patient with severe systemic disease● ASA 4 : Patient with severe systemic disease

that is a constant threat to life● ASA 5 : A moribund patient who is not expected

to survive without the operation● ASA 6 : A delcared brain-dead patient whose

organs are being harvested

Airway Assessment

● Decreased neck range of motion● Decreased mouth opening● Large tongue● Redundant airway tissue

Airway Assessment

Monitoring Capabilities

● Supplemental Oxygen● Working IV● Pulse Ox, NBP, EKG● Suction● Readily accessible rescue drugs● Accessible crash cart

Current Patient Condition

● Screening– Screening is typically 50 year old undergoing their

first Colonoscopy– Can “assume” this patient is prepped and medically

optomized for the procedure

● Diagnostic– Something is wrong with this patient– What is it???– How sick is this patient?

Levels of Sedation

● Sedation is defined as a drug induced depression in the level of consciousness to relieve anxiety and discomfort, improve the outcome of the procedure, and diminish the patient's memory of the event

Levels of Sedation

● Light Sedation (Anxiolysis)– Patient is easily aroused– Airway is unaffected– Spontaneous ventilation is unaffected– Cardiovascular function is unaffected

● Moderate Sedation (Conscious sedation)– Patient responds to verbal or touch stimuli– No intervention necessary for airway– Adequate spontaneous ventilation– Cardiovascular usually maintained

Levels of Sedation

● Deep Sedation– Patient responds to repeated or painful stimuli– Airway intervention may be required– Spontaneous ventilation may be inadequate– Cardiovascular function is usually maintained

● General Anesthesia– Patient is unarousable even to painful stimuli– Airway intervention is often required– Spontaneous ventilation is usually inadequate– Cardiovascular function may be impaired

Scenario

● During an EGD, the patient begins to snore. What is the anesthetist thinking?

● Breathing becomes more erratic. Sats decreased to 85%

● What is the antedote for Propofol?● What do we need to do?● Why is IV access such a concern?

References

● Stoelting RK, Miller RD. Basics of Anesthesia. Fifth Edition. 2007; 540-551.

● Sedation and anesthesia in GI endoscopy. Gastrointestinal Endoscopy 2008, 68; 815-826.