ANAESTHESIA IN THE GASTROINTESTINAL ENDOSCOPY SUITE
Dr. Jaya Susan Jacob, Lakeshore Hospital & Research Centre, Kochi
Anesthesiologists are often called upon to provide care to patients undergoing diagnosticand therapeutic procedures outside the operating room. One of the common locations isthe gastrointestinal endoscopy suite. It is vital that we strive to maintain the same highstandards of anaesthesia care as in the operating room despite the physical and logisticconstraints imposed by the environment.Ideal requirements for providing safe anaesthesia care include the availability of piped andcylinder oxygen, suction, anaesthesia machine and components, good illumination,monitoring equipment, emergency cart and defibrillator
to name a few. But the verynature of many procedures demand that some of these requirements are not available athand. Familiarity with the layout, the procedure and the patient will go a long way in
making the anesthesiologist’s work less stressful.
Procedures commonly done in the GI endoscopy suite includeUpper GI endoscopy Flexible sigmoidoscopyEndoscopic retrograde cholangiopancreatography Liver biopsyEndoscopic ultrasonography EnterescopyPercutaneous transhepatic biliary drainage Stent placements, removalColonoscopy Transjugular intrahepaticportosystemic shuntThe indications for endoscopy may be diagnostic (upper and lower GI bleed, infection,malignancy or postsurgical evaluation) and/or therapeutic (variceal bleed, angiodysplasia,foreign body removal, stricture dilatation, stent placement). GI endoscopy though mostlysafe can have some complications. Among the more common of these are cardiopulmonarycomplications such as hypotension, hypoventilation, airway obstruction. Complications dueto instrumentation such as bleeding, perforation and infection are less frequent. Still rarerare life threatening complications such as aspiration, myocardial infarction and pulmonaryembolism.According to guidelines laid down by ASA task forceAnesthesiologist assistance may be considered for
Prolonged/ therapeutic endoscopic procedure requiring deep sedation
Anticipated intolerance to standard sedatives