Anesthesia for Routine and Advanced Upper Gastrointestinal Endoscopic Procedures

Sharp, Christopher; Tayler, Ezekiel; Ginsberg, Gregory G.

doi:10.1016/j.anclin.2017.08.006

Cited by 11 publications

(12 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Routine OTI provides optimal control of the airway, according to the primum non nocere strategy, but requires time and is reserved for selected procedures. [ 1 12 ] Daily routine is supposed to be run with GA without OTI, partly because it has become a safe procedure (need for supination 1/153) if administered by skilled personnel and partly because of the elevated turnover, particularly if the activity takes place in tertiary referral centers. A consistent quote of experience in this setting becomes extremely valuable when there is a need to quickly evaluate a patient and decide if the patient can afford a GA with spontaneous breathing procedure or needs OTI.…”

Section: Discussionmentioning

confidence: 99%

“…A consistent quote of experience in this setting becomes extremely valuable when there is a need to quickly evaluate a patient and decide if the patient can afford a GA with spontaneous breathing procedure or needs OTI. [ 1 ] The anesthesiologist must therefore heighten his skill in the management of the airway to counterbalance the absence of a secure airway, which remains the major concern. [ 8 ] The standard source of oxygen, i.e., nasal cannulae, could easily become inadequate.…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 12 19 ] The current opinion recommends the creation of a small pool of anesthesiologists dedicated to invasive endoscopic/radiologic procedures and familiar with the unusual location (NORA team). It has been demonstrated that regular anesthesiologists are more efficient than occasional colleagues[ 1 5 19 ] and may be helpful in terms of cost-saving and, much more than this, of patient safety. Measured values of mean oxygen saturation were higher when sedation or anesthesia was administered by a dedicated pool.…”

Section: Discussionmentioning

confidence: 99%

“…The time required and the increasing complexity of such maneuvers require avoiding unconscious movements. [ 1 ] General anesthesia (GA), as defined by the ASA statement,[ 2 ] can be considered the choice. [ 3 4 ] GA can be administered to a prone patient breathing spontaneously (as in our institution), with limited possibility to support ventilation due to shared airway.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Non-intubated general anesthesia in prone position for advanced biliopancreatic therapeutic endoscopy: A single tertiary referral center experience

et al. 2022

View full text Add to dashboard Cite

Background and Study Aim: Advance biliopancreatic endoscopies are nowadays performed in non-operating room anesthesia (NORA) under general anesthesia (GA). We evaluate the outcomes of non-intubated patients in prone position who received GA for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in a tertiary referral center for digestive endoscopy. Patients and Methods: Anesthesiological records, anamnestic, and intraoperative data of patients who underwent advanced therapeutic biliopancreatic endoscopies at our tertiary referral center from January 2019 until January 2020 were collected in the present observational study. Results: One hundred fifty-three patients (93 M; median age: 68-year-old; mean ASA status: 2) were considered eligible for a procedure in the prone position with GA in spontaneous breathing. Prone position was always the initial setting. Propofol administration through a target-controlled infusion (TCI) pump was the choice to achieve GA. In our experience, desaturation appears to be the most frequent adverse event, accounting for 35% of cases (55/153). Treatment foresaw additional oxygen through a nasopharyngeal catheter, which proved to be a sufficient measure in almost all patients (52/55). Other adverse events (i.e., inadequate sedative plan, pain, and bradycardia) accounted for 2.6% of cases (4/153). Conclusions: Non-intubated GA in the prone position may be regarded as a safe procedure, as long as the anesthesiological criteria of exclusion are respected and the anesthesiological team has become acquainted with the peculiar NORA setting and familiar with the management of possible adverse events.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Non-intubated general anesthesia in prone position for advanced biliopancreatic therapeutic endoscopy: A single tertiary referral center experience

et al. 2022

View full text Add to dashboard Cite

show abstract

“…A basic diagnostic EGD is a reasonably fast treatment that only involves 30 minutes of sedation. Sedation may be given for diagnostic upper EGD with either mild sedation or controlled anesthesia treatment (MAC) with [3,4]. Nitrous oxide-sedation is also a safe and reliable alternative for patients undergoing digestive endoscopy [5,6,7].…”

Section: Introductionmentioning

confidence: 99%

Nitrous Oxide Occupational Exposure in Conscious Sedation Procedures in Endoscopic Ambulatories: A Pilot Retrospective Observational Study in an Italian Hospital

Borrelli

Pastorino

Buccico³

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Nitrous oxide is widely used to induce sedation; however, its use outside of operating rooms – such as in ambulatory rooms – is not properly controlled by norms. In the lack of supervision, there is a chance of workplace exposures for the operators engaged in the outpatient use of nitrous oxide. The aim of this research is to assess nitrous oxide exposure in gastroenterology outpatient settings. Methods: We performed an observational study with a first step marked by nitrous oxide environmental testing in a gastroenterology outpatient care where colonoscopies were practiced; environmental research was supported by biological monitoring with urinary N2O analysis in exposed operators. The research was conducted in the absence and then in the presence of a collective security device (Niki mask). Results: The study was rolled out in 10 sessions of day shift procedures, totaling 4105 samples. The average nitrous oxide concentration in the environment was 27.58 (SD 1.76) and 449.59 (SD 35.29), respectively with and without Niki Mask; the distribution of gases in the environment under investigation was not homogeneous (Anova test p.001). Biological testing revealed a substantial rise in urinary concentration of 8.97 (p.001) between the start and the end of the shift, and the use of the Niki mask was effective (p=.003). Conclusions: The exposure levels reported in environmental sampling exceed the limits of 50 ppm (the value set for operating rooms in Italy) as well as the value of 25 ppm (NIOSH threshold value), indicating a significant issue in the outpatient use of nitrous oxide. It is evident that technical measures are needed to contain the occupational risk from Nitrous oxide exposure outside of operating rooms, and that even the basic use of Niki masks would not be sufficient to minimize professional exposure and protect workers; for the exposure results detected in this research, it is also plain that exposures must be subject to health surveillance.

show abstract

Airway Management in out of the Operating Room Environments

Elsamragy

Vats

Osborn

2020

Curr Anesthesiol Rep

View full text Add to dashboard Cite

Anesthesia for Routine and Advanced Upper Gastrointestinal Endoscopic Procedures

Cited by 11 publications

References 13 publications

Non-intubated general anesthesia in prone position for advanced biliopancreatic therapeutic endoscopy: A single tertiary referral center experience

Non-intubated general anesthesia in prone position for advanced biliopancreatic therapeutic endoscopy: A single tertiary referral center experience

Nitrous Oxide Occupational Exposure in Conscious Sedation Procedures in Endoscopic Ambulatories: A Pilot Retrospective Observational Study in an Italian Hospital

Airway Management in out of the Operating Room Environments

Contact Info

Product

Resources

About