Esophagoscopy/Gastroscopy

Question 1

What are the most common gastrointestinal

endoscopic procedures?

Answer 1

Colonscopy, esophagogastroduodenoscopy (EGD),
sigmoidoscopy, and endoscopic retrograde
cholangiopancreatography (ERCP).

Question 2

What are the anesthetic implications of the patient

undergoing colonoscopy?

Answer 2

Patients may present with hemodynamic instability due to hypovolemia from the bowel preparations and prolonged NPO status. Anemia may also be present in patients undergoing
evaluation of gastrointestinal bleeding.

Question 3

Why is anesthesia frequently involved in the

performance of colonoscopies?

Answer 3

Although the procedure has historically been performed under mild sedation administered by the endoscopist, there has been an increase in resistance by patients to undergo the procedure
without a deeper level of sedation due to fear of discomfort.

Question 4

What are the potential complications of an upper

endoscopy that are significant to the anesthetist?

Answer 4

Upper airway obstruction complicated by limited access to the face and head, perforation of the upper GI tract, bleeding, and bradycardia or other arrhythmias arising from distention of the
GI tract.

Question 5

How is the patient typically positioned for an
endoscopic retrograde cholangiopancreatography
(ERCP)?

Answer 5

The patient is either in an extreme lateral or prone position

Question 6

Is pregnancy a contraindication to

esophagogastroduodenoscopy?

Answer 6

No. EGD has been performed successfully in pregnant patients. Consideration should be given to the drugs administered to the parturient as they may pass to the fetus, but propofol and fentanyl have been shown to be safe. Midazolam
crosses the placenta and results in fetal depression, so it is not indicated for pregnant patients.

Question 7

Does endoscopy require antibiotic prophylaxis for

patients at risk for endocarditis?

Answer 7

No. Although it was previously required, antibiotics are no longer recommended for routine gastrointestinal procedures solely to prevent endocarditis.

Question 8

Is conscious sedation or TIVA suitable for all upper

endoscopic procedures?

Answer 8

Conscious sedation or TIVA is suitable for the vast majority of cases, but general endotracheal anesthesia may be required for patients with strong tendencies toward upper airway obstruction
or at high risk for aspiration. This should be discussed with the endoscopist as the endotracheal tube may make the procedure
difficult to perform.