Esophagoscopy/Gastroscopy

Question 1

What are the most common gastrointestinal

endoscopic procedures?

Answer 1

Colonoscopy, esophagogastroduodenoscopy (EGD),
sigmoidoscopy, and endoscopic retrograde
cholangiopancreatography (ERCP).
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1268.

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.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1269

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.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1269.

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.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1269.

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
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1269.

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.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1271-1272.

Question 7

Does endoscopy require antibiotic prophylaxis for

patients at risk for endocarditis?

Answer 7

Because EGD involves the instrumentation of the oropharynx
and trauma to the mucosa is a possibility (particularly when
biopsies are performed), bacteremia is a possibility and
antibiotic regimens are indicated as needed for patients at risk
for endocarditis.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 1271-1272.

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.
Longnecker DE, Newman MF, Brown DL, Zapol WM.
Anesthesiology. 2nd ed. New York: McGraw-Hill; 2012: 1269