Anesthesia for digestive tract endoscopy

Abstract

Purpose of reviewNonoperating room anesthesia for digestive tract endoscopy has its own specificities and requires practical training. Monitoring devices, anesthetic drugs, understanding of procedures and management of complications are critical aspects. Recent findingsNew data are available regarding risk factors for intra-and postoperative complications (based on anesthesia registries), airway management, new anesthetic drugs, techniques of administration and management of advances in interventional endoscopy procedures. SummaryDigestive tract endoscopy is a common procedure that takes place outside the operating room most of the time and has become more and more complex due to advanced invasive procedures. Prior evaluation of the patient's comorbidities and a good understanding of the objectives and constraints of the endoscopic procedures are required. Assessing the risk of gastric content aspiration is critical for determining appropriate anesthetic protocols. The availability of adequate monitoring (capnographs adapted to spontaneous ventilation, bispectral index), devices for administration of anesthetic/sedative agents (targetcontrolled infusion) and oxygenation (high flow nasal oxygenation) guarantees the quality of sedation and patient' safety during endoscopic procedures. Knowledge of the specificities of each interventional endoscopic procedure (endoscopic retrograde cholangiopancreatography, submucosal dissection) allows preventing complications during anesthesia.

Artificial intelligence and nonoperating room anesthesia

“…NORA for digestive tract endoscopy and related procedures, accounts for 17% of all anesthesia cases reported by the National Anesthesia Clinical Outcomes Registry (NACOR). This setting also represents the majority of NORA malpractice claims, accounting for 51% of NORA cases with 89% of these involving monitored anesthesia care [2,3]. These findings underscore the importance of following an evidence-based standard of care and ensuring safe practices for these frequently performed procedures.…”

Applications of artificial intelligence in gastroscopy: a narrative review

“…9 Quality control studies should investigate methods to comprehensively optimize these indicators by implementing AI technology, which can help to avoid narrowly focusing on quality control during the examination process. Careful analysis is needed concerning the pre-examination assessment of anesthesia risk, 10,11 as well as the rates of lesion detection during the examination and adverse reactions after the examination. 12 Exclusive reliance on manual methods to review data and conduct statistical analyses constitutes an inefficient approach.…”

Advances in Analgosedation and Periprocedural Care for Gastrointestinal Endoscopy

“…Capnography is especially indicated in general anesthesia because it can be used to confirm the existence of apnea and airway obstruction more easily. Capnography can also reduce adverse events associated with respiratory depression [ 57 , 58 ]. Additional monitoring, such as invasive pressure measurement, can be used in long-term therapeutic endoscopic procedures, depending on the patient’s comorbidities.…”

“…Due to all the above, and due to the recognition of adverse events, the presence of an anesthesiologist during sedation for gastrointestinal procedures is recognized as useful, as it reduces the possibility of unwanted consequences, improves patient satisfaction, and improves the patient’s post-procedural recovery [ 57 , 72 ].…”