Anaesthesia for endoscopy

Published on 09/04/2015 by admin

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Last modified 09/04/2015

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Chapter 29 ANAESTHESIA FOR ENDOSCOPY

KEY POINTS

• Patients do not need a deep level of anaesthesia, only moderate sedation—drug-induced depression of consciousness.
• A review of medications and results of investigations is necessary, in particular the presence of hepatic or renal impairment, which affects drug clearances and half-lives.
• All patients need reliable intravenous access, oxygen, pulse oximetry, accessible Ambu bag, emergency drugs, reversal drugs for benzodiazepines and narcotics and access to an electrocardiogram (ECG) and defibrillator.
• Sedation for endoscopy requires a combination of drugs. Midazolam, fentanyl and propofol are used in varying amounts to increase the comfort and tolerance of the patient to the procedure.

INTRODUCTION

In order to undertake upper or lower gastrointestinal endoscopy patients must be anaesthetised in some way. They do not need a deep level of anaesthesia, only moderate sedation—drug induced depression of consciousness. The purpose of this chapter is to give an outline of patient assessment (see Chapter 28 for more information), monitoring and drugs used in order to sedate patients undergoing procedures.

PATIENT ASSESSMENT

• Identification and introduction of anaesthetist to patient.
• Appropriate medical assessment of patient, especially cardiovascular and respiratory history (questionnaires are often helpful).
• Ask about previous sedation, anaesthetics, allergies, fasting and damaged or loose teeth (this is of particular interest for upper endoscopy).
• Clinical examination, review of medications and results of investigations. Hepatic and renal impairment are particularly relevant as they affect drug clearances and half-lives.

MONITORING CHECKLIST

• All patients need reliable intravenous access.
• All should have oxygen.
• All patients should have pulse oximetry.
• Pulse rate should be palpated and recorded.
• Blood pressure should be recorded.
• Electrocardiogram (ECG) and capnography may be required if cardiovascular or respiratory history.
• There should be an ambubag nearby (or means of inflating lungs).
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