Anaesthesia for Endoscopy
Oct 25, 2024
Smooth Sailing - Anaesthesia for Endoscopy 🏥
Anaesthesia in the endoscopy unit is dynamic and fast-paced. Understanding the nuances of anaesthesia specific to endoscopic procedures is essential for optimising patient safety and promoting positive outcomes. ✅
For most endoscopic procedures, such as gastroscopy and colonoscopy, the primary mode of anaesthesia is sedation. This facilitates comfort and cooperation of the patient whilst avoiding a general anaesthetic.
Sedation is not a one-stop shop, but more a continuum that ranges from light, minimal levels all the way through to deep sedation and beyond to general anaesthesia. It can roughly be broken into three levels:
🟢 Minimal - reduced anxiety, patient is still conscious and responding to verbal commands or light touch.
🟡 Moderate - depressed consciousness, can still respond to verbal commands and tactile stimulation.
🔴 Deep - depressed consciousness, not easily roused and likely only responds to noxious stimuli.
The target range of sedation for a patient will be dependent on procedural requirements and interventions, as well as patient factors and comorbidities. A common misconception in the endoscopy unit is that "it's only sedation". In Australia, most endoscopy procedures are performed with deep propofol sedation, which carries a higher risk of airway obstruction, aspiration and haemodynamic consequences than light/moderate sedation.
Key points:
🛑 Through the varying levels of sedation, patients may require some airway support such as a chin lift - capnography monitoring can aid in determining this.
⚠️ As sedation is a continuum, it can be tricky to titrate effectively and can rapidly progress to deeper levels and into general anaesthesia inadvertently.
🚑 There is always the chance that you may need to convert to a general anaesthetic quite rapidly, so airway equipment like an ETT and rescue devices such as LMAs should be readily available.
🧑⚕️ With general anaesthesia being less common in endoscopy units, skills and recency of practice in assisting with intubation can vary between anaesthetic assistants. Regular training and simulation can be helpful to maintain these skills.
✅ Build Knowledge
✅ Improve Safety
References:
ANZCA (2023). PG09(G) - guideline on precodural sedation 2023. https://www.anzca.edu.au/getattachment/c64aef58-e188-494a-b471-3c07b7149f0c/PG09(G)-Guideline-on-sedation-and-or-analgesia-for-diagnostic-and-interventional-medical,-dental-or-surgical-procedures-(PS09)
Sneyd, J.R. (2022). Developments in procedural sedation for adults. BJA Education. V22(7) pp 258-264. DOI: 10.1016/j.bjae.2022.02.006
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