ANAESTHESIA FOR UPPER GI ENDOSCOPY

PRE-ASSESSMENT

• Day case or Inpatient
• Elective or Emergency
• Reason for procedure
• Co-existing medical conditions (ASA grade)
• Previous anaesthetics
• Drug and allergy history
• Teeth!

'STBUR' (Snoring, Trouble Breathing, UnRefreshed)
While sleeping, does your child …
1. … snore more than half the time?
2. … snore loudly?
3. … have trouble breathing, or struggle to breathe?
4. Have you ever seen your child stop breathing during the night?
5. Does your child wake up feeling unrefreshed in the morning?

CASE HISTORY

• 6 yr old girl
• Eosinophilic oesophagitis
• Sleep disordered breathing
• Anaesthetic anxiety
• Multiple food allergies
• Wobbly front teeth

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• Repeated anaesthetics Premedication Parental presence Behavioural therapy/psychology
• Which drugs are safe to use?
• Does she need a post-operative bed for monitoring?

Food and milk 6 hours
Breast milk 4 hours
Water 2 hours

Intravenous induction
Propofol

Inhalational induction
Sevoflurane

ETT
Definitive secure airway
Muscle relaxation
Sore throat
Respiratory adverse events

LMA
Supraglottic device
3% failure
Quick turnover list

Nasal cannulae and iv sedation
Experienced team including Anaesthetist

Shared airway

• Supine vs left lateral
• Ventilation and hypoxia
• Aspiration of stomach contents
• Keep 'asleep'
• Avoid dislodging airway

Intraoperative

• Low analgesic requirement
• Anti-emetics- ondansetron and dexamethasone
• Aspirate stomach

Special circumstances

• Acute GI bleed
• Retrieval of FB eg battery
• Banding varices

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