Barriers to Effective Airway Management During Endoscopy
Nov 07, 2024
One of the most dangerous statements in anaesthesia is “it’s only sedation”.
Endoscopy is often performed in remote locations, in a dark and crowded environment, with poor positioning, junior staff, and limited airway equipment. It is vital to understand the barriers to effective airway management so you can safely anticipate and manage airway issues.
Here are 5 possible barriers to effective airway management in the endoscopy unit:
1️⃣ Deep sedation
👉 In Australia, most endoscopy procedures are performed under deep sedation with propofol. According to ANZCA, deep sedation is “A drug-induced state of depressed consciousness during which patients are not easily roused and may respond only to noxious stimulation … Loss of consciousness with its attendant risk of loss of protective airway reflexes may occur rapidly and unexpectedly.”
🔺 As endoscopy is not routinely performed with a secure airway, this deep sedation carries elevated risk of airway obstruction, aspiration, laryngospasm, and hypoxia.
2️⃣ Position
👉 Endoscopy is performed in the left lateral position. With gastroscopy, the patient is facing the proceduralist and may be some distance from the anaesthetic machine. Returning to the supine position may be necessary to perform airway rescue, and the anaesthetic circuit may need to be extended.
🔺 A common pitfall is forgetting to connect the CO2 line or forgetting to turn on the machine oxygen.
3️⃣ Staff
👉 As endoscopy anaesthesia is “only sedation,” it is often allocated to junior or non-anaesthetic staff.
🔺 Lack of experience or technical ability can impact the ability to safely perform airway rescue.
4️⃣ Equipment
👉 Endoscopy units may have unfamiliar anaesthetic trolley layouts, different anaesthetic machines, and may lack easy access to a video laryngoscope or difficult airway trolley.
5️⃣ Preparedness
👉 Since every patient on the list is booked for “sedation,” a shared plan for airway rescue may be overlooked.
🔺 This lack of planning reduces the effectiveness of teamwork, communication, and overall willingness to act in an emergency.
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References: Ref: Australian and New Zealand College of Anaesthetists. (2022). PG09(G) Guideline on Procedural Sedation 2022 [Pilot]. Retrieved from https://www.anzca.edu.au/getattachment/c64aef58-e188-494a-b471-3c07b7149f0c/PG09(G)-Guideline-on-procedural-sedation-2022-PILOT
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