Anesthetic Considerations for

Endoscopic Procedures
(Pre-op, Intra-op, Post-op)
Ziegfried L. Loo Tian, R.M.T., M.D., D.P.B.A.
 Anesthesia
• Loss of sensation with or without loss of
consciousness
• Artificially induced insensitivity to pain
• To render a patient pain free, enabling them to
tolerate a certain procedure
Endoscopy
Endoscopic Procedures
EGD

Colonoscopy

EUS

Sigmoidoscopy

ERCP

Enteroscopy

PEG Tube Insertion

Pre-Procedure
Pre-procedure considerations

1 2
Airway
Solids: 6 or 8 hours
Co-morbidities
Clear Liquids: 2 or 3 hours
Allergies
NPO
Maintenance Medications

Pre-procedure Assessment Pre-procedure Fasting

Procedure Proper
 Anesthetic Technique
• MAC - Monitored Anesthesia Care
• MAC with sedation - Monitored Anesthesia
Care wtih sedation (benzodiazepines, opioids)
• TIVA - Total IntraVenous Anesthesia
(barbiturates, propofol)
• GA - General Anesthesia (volatile anesthetics)
 Anesthetic Medications
• Benzodiazepines • Fentanyl
– Hypnotic – Opioid analgesic
– Sedative – Exhibits synnergism with
– Amnesic (anterograde) benzodiazepines
– Anti-epileptic • Respiratory depression
– Spinal cord mediated • Abuse potential
skeletal muscle relaxation • Onset: 6 - 7 minutes
• Respiratory depression • Duration: 30 - 60 minutes
• Fatigue and drowsiness
• Abuse Potential
• Midazolam (1-3/ 30-80)
• Diazepam (1 / 60-120)
• Lorazepam (5-10/ 120-
360)
• Alprazolam (PO only)
 Anesthetic Medications
• Barbiturates
– Thiopental
– Hypnotic sedative
– Neuroprotective
• Respiratory depression
• Cardiac depression
• Pain on injection
• Onset: 30 - 45 seconds
• Duration: 5 - 10 minutes
• Propofol
– Hypnotic sedative
– Can be used even in cirrhotic
patients
– 30 minutes
– Anti-emetic
• Respiratory
depression/apnea
• Cardiac depression
• Allergies
• Abuse potential
• Pain on injection
• Onset: 15 - 30 seconds
• Duration of action: 5 - 10
minutes
Anesthetic Medications
Volatile anesthetic for GA
• Anesthesia machine
• Sevoflurane
• Sevoflurane vaporizer
• Anesthesia breathing
circuit and mask
• Oxygen
 Emergency Medications
• Vasopressors/Inotropes
– Ephedrine
– Phenylephrine
– Dopamine
– Epinephrine
– Dobutamine
– Norepinephrine
• Atropine
 Monitoring
• Standard I
– Qualified anesthesia
personnel
• Standard II
– Oxygenation
– Ventilation
– Circulation
– Temperature
Airway Management

Nasal cannula (with or without opening the airway)

Nasopharyngeal airway (NPA)

Endoscopy mask

Supraglottic airway
Airway Mangement – Nasal Cannula
Airway Mangement – Nasopharyngeal
Airway (NPA)
Airway Management – Endoscopy
Mask
 Opening the Airway
Head tilt & chin lift Jaw thrust
Bag Mask Ventilation
1 man vs. 2 man E-C Clamp Technique
E-V Clamp
 Airway Management – Supraglottic
Airways
Gastro Laryngeal Tube LMA Gastro
 Anesthetic Requirements
Choice of anesthetic is largely operator
dependent
• Topical/local anesthetics
• Benzodiazepines (midazolam/diazepam)
• Opioids (fentanyl/meperidine)
• Benzodiazepine+opioid
• Barbiturates/Propofol
• Inhalational
 Common Problems
• Hypotension
• Airway obstruction
• Respiratory depression
Post-Procedure
 Post Procedure
• PACU (Standard I) • Hypotension
– Cardiac monitor for each • Nausea/vomiting
bed
– Oxygen supply
• Dizziness
• Accompanied by anesthesia • Pain
team member (Standard II) • Hypothermia
• Proper handoff (Standard III)
• Continually evaluated by
qualified nursing personnel
(Standard IV)
• Discharge by physician
(Standard V)
Thank you