Ambulatory GI anesthesia with no anesthesia equipment?

[coffeebythelake]

To play devil's advocate: how many times have you intubated a GI case?
Me? A big 0 for thousands of cases... (channeling my inner Blade) once i masked a couple of breaths with the ambu bag.
With appropriate technique (low and slow) you really only need a little oxygen via nasal canula and a pulse ox.

U never had a GI patient aspirate?

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[Southpaw]

U never had a GI patient aspirate?

He's not in the US. He doesn't routinely do GI anesthesia for super sick super morbidly obese patients who are already half dead. He also may not routinely do food bolus cases for people who can't swallow their food. And he may not do emergent upper GI bleeds in full stomachs who are on the verge of death.

 

[DrOwnage]

He's not in the US. He doesn't routinely do GI anesthesia for super sick super morbidly obese patients who are already half dead. He also may not routinely do food bolus cases for people who can't swallow their food. And he may not do emergent upper GI bleeds in full stomachs who are on the verge of death.

This is like 50% of the inpatient endos I do. Ughh.

 

[Arch Guillotti]

To play devil's advocate: how many times have you intubated a GI case?
Me? A big 0 for thousands of cases... (channeling my inner Blade) once i masked a couple of breaths with the ambu bag.
With appropriate technique (low and slow) you really only need a little oxygen via nasal canula and a pulse ox.

You must have a much different patient population. We routinely see bad gi bleeds and full stomachs that nobody in their roght mind would without a secure airway.

 

[dhb]

You must have a much different patient population. We routinely see bad gi bleeds and full stomachs that nobody in their roght mind would without a secure airway.

We were talking outpatient basic screening GI procedures not emergency trainwrecks

 

[dhb]

U never had a GI patient aspirate?

Just this wednesday . CRNA was doing the case, regurgitation during the procedure, then i was called because the patients temperature spiked to 39°C.
Put her on atbx next day scan showed lingular infiltrate... did well, left today.
But that case could still have been done in an outpatient facility and then transfered to the hospital when the problem occured

 

[GassYous]

I did an ercp in a patient with asthma last week with sedation only (usually I tube but she did well with the same procedure/anesthesia a few weeks prior). On removal of scope some bile came out and patient aspirated a little. Watched her in pacu for an hour and she was okay but damn that sucked.

Cirrhotics, diabetics, eosinophilic esophagitis with food stuck, etc. are a dime a dozen.

 

[deleted171991]

I did an ercp in a patient with asthma last week with sedation only (usually I tube but she did well with the same procedure/anesthesia a few weeks prior). On removal of scope some bile came out and patient aspirated a little. Watched her in pacu for an hour and she was okay but damn that sucked.

Cirrhotics, diabetics, eosinophilic esophagitis with food stuck, etc. are a dime a dozen.

Risks vs benefits. One can do the right thing and still have a complication.

I think you probably did the right thing (unlike the ***** who didn't suction her stomach during scope removal).

 

[dhb]

We routinely see bad gi bleeds and full stomachs

We always tell the GE that we can't do a GA because they are full stomachs so they're used to handle them without us.