Anesthetic management for small bowel enteroscopy in a World Gastroenterology Organizing Endoscopy Training Center (original) (raw)
Related papers
World journal of gastrointestinal endoscopy, 2012
To study the anesthetic management of patients undergoing small bowel enteroscopy in the World Gastroenterology Organization (WGO) Endoscopy Training Center in Thailand. Patients who underwent small bowel enteroscopy during the period of March 2005 to March 2011 in Siriraj Gastrointestinal Endoscopy Center were retrospectively analyzed. The patients' characteristics, pre-anesthetic problems, anesthetic techniques, anesthetic agents, anesthetic time, type and route of procedure and anesthesia-related complications were assessed. One hundred and forty-four patients underwent this procedure during the study period. The mean age of the patients was 57.6 ± 17.2 years, and most were American Society of Anesthesiologists (ASA) class II (53.2%). Indications for this procedure were gastrointestinal bleeding (59.7%), chronic diarrhea (14.3%), protein losing enteropathy (2.6%) and others (23.4%). Hematologic disease, hypertension, heart disease and electrolyte imbalance were the most commo...
Journal of Gastroenterology and Hepatology Research
AIM: trainee-administered propofol deep sedation (PDS) by using a syringe pump for small bowel enteroscopy (SBE) procedure between patients aged<65 years and patients aged65 years in an endoscopic unit outside operating room in Thailand. METHODS: We undertook a retrospective review of SBE < 65 years) and group B (age 65 years). The primary outcome variable of the study was the successful completion of procedure. Secondary outcome variables were sedation-related complications during and immediately after the procedure. RESULTS: After matching the patients’ characteristics, duration and indications of procedure, there were 45 patients in group A in characteristics of patients, duration of procedure and indications of procedure between the two groups. All sedations were used differences in overall, respiratory and cardiovascular-related complications between the two groups. However, hypotension in CONCLUSION: In the setting of endoscopy unit outside operating room, PDS by anesthetic trainee using a syringe pump for SBE procedure in elderly patients with appropriate monitoring was elderly patients was not different or worse than in younger patients. However, the rate of hypotension was significantly high in the elderly patients than younger patients. Serious complications were rare.
Anesthesia Innovations for Endoscopy of Gastrointestinal Tract
Gastrointestinal endoscopy (GIE) is a procedure for diagnosis and treatment of gastrointestinal tract abnormalities. This procedure requires some forms of anesthesia. The goal of procedural anesthesia is safe, effective control of pain and anxiety, as well as an appropriate degree of memory loss or reduced awareness. Generally, the majority of GIE procedures are performed by using topical anesthesia and intravenous sedation. General anesthesia is carried out in long and invasive procedures such as endoscopic retrograde cholangiopancreatography, endoscopic ultrasound, and small bowel enteroscopy, as well in patients with history of failed sedation or drug and substance abuse, uncooperative or pediatric patients, and patients with cardiorespiratory system instabilities. The appropriate anesthetic agents for GIE procedures could be short acting, rapid onset with little adverse effects and also improved safety profiles. To date, the new anesthetic drugs and monitoring equipments for safety and efficacy are available. The present review focuses on pre-anesthetic assessment, anesthetic drugs used, monitoring practices, and post-anesthesia care for anesthesia innovations in GIE procedures.
Digestive Diseases and Sciences, 2014
Background General endotracheal (GET) anesthesia is often used during single-balloon enteroscopy (SBE). However, there is currently limited data regarding monitored anesthesia care (MAC) without endotracheal intubation for this procedure. Aims The aim of the study was to determine the safety and efficacy of MAC sedation during SBE and to identify risk factors for adverse events. Methods All patients who underwent SBE and SBEassisted endoscopic retrograde cholangiopancreatography between June 2011 and July 2013 at a tertiary-care referral center were studied in a retrospective analysis of a prospectively collected database. Patients received MAC anesthesia or GET. The main outcome measurements were sedation-related adverse events, diagnostic yield, and therapeutic yield.
Anaesthetic Considerations in Gastrointestinal Endoscopies
Gastrointestinal endoscopy has become fundamental procedure for diagnosis and treatment of gastrointestinal tract diseases. Generally, the gastrointestinal endoscopy is minimally invasive procedure. However, it can cause considerable amount of discomfort and pain which make the procedure unsafe, complicated and refusal of follow up procedures if done without safe sedation. The sedation is required to alleviate anxiety, provide analgesia, amnesia and to improve endoscopic performance specifically in therapeutic procedures. The safe administration of sedative and analgesic medications, irrespective of the regimen used, requires knowledge of the individual needs of patients. The combination of benzodiazepines and opioids is now the most widely used sedation regimen for sedation in gastrointestinal endoscopic procedures. Generally, sedation for gastrointestinal endoscopy is considered safe, however, it has the potential for serious complications. Therefore, endoscopist should assess the patients properly before the endoscopy as well as should be aware of all possible complications and the risk factors. Furthermore, skilled staff and emergency equipment should be available in endoscopy suit. This chapter discuss in details all the aspects of safe procedural sedation during GI endoscopies.
Anesthesia Related Complications of Gastrointestinal Endoscopies; A Retrospective Descriptive Study
Middle East Journal of Digestive Diseases, 2019
BACKGROUND Gastrointestinal endoscopic procedures are widely used for diagnostic and therapeutic measures. Analgesia and sedation/anesthesia are inseparable parts of these studies and their related complications are inevitable. METHODS In a retrograde descriptive study in Shahid Beheshti Hospital, affiliated to Qom University of Medical Sciences, Qom, Iran from March 2013 to March 2017, we gathered information regarding common anesthesia related complications and analyzed them. RESULTS 44659 procedures were performed during the study period and records of 21342 men (47.79%) and 23317 women (52.21%) were evaluated. Hemodynamic instability (9998; 22.39%), dysrhythmia (1600; 3.58%), desaturation (608; 1.36%), prolonged apnea (34; 0.08%), aspiration (43; 0.10%), postoperative nausea and vomiting (PONV) (636; 1.42%), headache (106; 0.24%), delirium (51; 0.11%), aphasia (1; 0.00%), masseter muscle spasm (1; 0.01%), myocardial infarction (2; 0.00%), and death (5; 0.01%) were seen in the pa...
Medeniyet Medical Journal
Objective: This study aimed to analyze patients undergoing endoscopic interventions in terms of comorbid diseases, preoperative anesthesia management predictions, intraoperative-postoperative complications and requirements for intensive care. Method: Records of patients who underwent procedures under anesthesia in the endoscopy unit were retrospectively screened. The patients' preoperative anesthesia evaluation, intraoperative anesthesia, and postoperative recovery data and intensive care monitoring requirements were recorded. The data obtained were analyzed statistically. Results: It was identified that the preoperative risk prediction of patients was statistically significant for intraoperative and postoperative monitoring. Comorbid disease and high age were determined to increase the requirements for intensive care after the procedure. Increased need for qualified admission was determined in patients with desaturation and hypotension. Conclusion: A prerequisite for reliable administration of anesthesia is having detailed information about the patient and being prepared for possible complications. When examined from this aspect, analysis of the patient profile undergoing procedures in the endoscopy unit is important. In our study, we revealed the presence of elderly patients and comorbid disease(s) in the patient group who underwent procedures in this unit. The need for detailed preliminary evaluation of the patients undergoing these types of procedure and requirements for intensive care after the procedure, if necessary, should definitely be considered.
Anesthesia for pediatric gastrointestinal endoscopy in a tertiary care teaching hospital
Thai Journal of Anesthesiology, 2008
Background : Pediatric gastrointestinal endoscopy (GIE) is a procedure for diagnosis and treatment of GI abnormalities. It can be performed without sedation, with intravenous sedation or with general anesthesia. The methods by which a child is anesthetized remain controversial. Objective : To evaluate the clinical efficacy of anesthesia/sedation for pediatric GIE in a tertiary-care teaching hospital in Thailand. Methods : Retrospectively analyzed the children on whom GI endoscopy had been performed during the period of January, 2006 to June, 2008 in Siriraj Hospital. The patients’ characteristics, pre-anesthetic problems, anesthetic techniques, agents, time and complications, as well as endoscopic procedures were assessed and summarized by using descriptive statistics. Results : There were 258 cases and 274 endoscopic procedures ; i.e. esophagogastroduodenoscopy (EGD (87.2%), colonoscopy (5.4%), EGD and colonoscopy (6.2%) and others (1.2%). Mean age was 8.2 (SD, 4.6) years and ranged from 4 months to 17 years. The majority of them were classified in ASA class III (37.2%). Patients most often had esophageal varice (22.5%), abdominal pain (15.5%), upper gastrointestinal hemorrhage (12.8%), anemia (10.5%), corrosive esophagitis (6.2%) and others. Most common pre-anesthetic problems were hematologic diseases (63.4%), liver diseases (45.9%) and electrolyte imbalance (20.9%). Intravenous sedation (65.5%) and general anesthesia with endotracheal tube (15.9%) were the main anesthetic techniques. The main anesthetic agents used were propofol, fentanyl and midazolam. Mean duration of endoscopy was 30.2 minutes and ranged in time from 10 to 110 minutes. Overall complication rate was 17.8%. Hypotension (12.8%) was the most frequent anesthetic complication. Conclusion : Anesthesia / sedation performed by anesthetic personnel for pediatric GIE is relatively safe and effective. Serious adverse events are rare.
Sedation and Anesthesia in Gastrointestinal Endoscopy: Indian Scenario
Journal of Digestive Endoscopy
Sedation in endoscopy is a drug-induced depression in the level of consciousness. Traditionally, the sedation regime most commonly used for conscious sedation during gastrointestinal (GI) endoscopy was a combination of opioids and benzodiazepines. However, in the last two decades, propofol is regarded as the sine qua non agent for gastroenterological endoscopic sedation. A thorough risk evaluation before the procedure and monitoring during the procedure are paramount. In elective endoscopy, unplanned adverse events are rare, occurring in 1.4% of procedures. All currently available guidelines state that the endoscopist is not permitted to administer propofol and to monitor the patient. This task must be done by an additional person, who has the sole responsibility of administering the sedative and monitoring the patient. Various scoring systems exist for defining the discharge criteria, of which the Aldrete score is the most commonly used.