Clin Endosc.  2022 Jan;55(1):1-7. 10.5946/ce.2021.236.

Anesthesia for Advanced Endoscopic Procedures

• Goudra B
• Saumoy M

• KMID: 2525041
• DOI: http://doi.org/10.5946/ce.2021.236

Abstract

The gastrointestinal endoscopy paradigm is rapidly changing, and technological advancements are largely responsible. In tandem, anesthesia providers are adapting to the changing needs and demands. The challenges are unique. Complications arising from the procedures are both routine, such as aspiration and hypoxia, and procedure specific, such as bleeding, pneumothorax, pneumopericardium, and pneumoperitoneum. It is crucial for the anesthesia provider to have a good understanding of the techniques employed by the endoscopist. A higher index of suspicion is also essential to diagnose and appropriately manage many of the complications. In this review, an effort is made to discuss both procedural aspects and anesthesia challenges. We hope that both endoscopists and anesthesia providers will benefit from this review.

Keyword

Anesthesia; Endobariatrics; Endoscopy; Myotomy

Figure

• 

  Fig. 1. Mapleson C breathing system in use in a obese patient undergoing esophageal dilation with propofol deep sedation.

• 

  Fig. 2. Head tilt–chin lift and jaw-thrust maneuvers in use to restore upper airway patency.

Reference

1. Goh YM, James NE, Goh EL, Khanna A. The use of endoluminal techniques in the revision of primary bariatric surgery procedures: a systematic review. Surg Endosc. 2020; 34:2410–2428.

2. Tawadros A, Makar M, Kahaleh M, Sarkar A. Overview of bariatric and metabolic endoscopy interventions. Ther Adv Gastrointest Endosc. 2020; 13:2631774520935239.

3. de Moura DTH, de Moura EGH, Thompson CC. Endoscopic sleeve gastroplasty: from whence we came and where we are going. World J Gastrointest Endosc. 2019; 11:322–328.

4. Jain D, Bhandari BS, Arora A, Singhal S. Endoscopic sleeve gastroplasty - a new tool to manage obesity. Clin Endosc. 2017; 50:552–561.

5. Fox M, Hebbard G, Janiak P, et al. High-resolution manometry predicts the success of oesophageal bolus transport and identifies clinically important abnormalities not detected by conventional manometry. Neurogastroenterol Motil. 2004; 16:533–542.

6. Torres-Villalobos G, Martin-Del-Campo LA. Surgical treatment for achalasia of the esophagus: laparoscopic Heller myotomy. Gastroenterol Res Pract. 2013; 2013:708327.

7. Goudra B, Singh P, Green M. Anaesthesia for uncommon and emerging procedures. New York (NY): Springer;2021.

8. Patel DA, Lappas BM, Vaezi MF. An overview of achalasia and its subtypes. Gastroenterol Hepatol (NY). 2017; 13:411–421.

9. Ali HA, Murali G, Mukhtar B. Respiratory failure due to achalasia cardia. Respir Med CME. 2009; 2:40–43.

10. Goudra B, Singh PM, Gouda G, Sinha AC. Peroral endoscopic myotomy-initial experience with anesthetic management of 24 procedures and systematic review. Anesth Essays Res. 2016; 10:297–300.

11. Pandolfino JE, Kahrilas PJ. Presentation, diagnosis, and management of achalasia. Clin Gastroenterol Hepatol. 2013; 11:887–897.

12. Ren Z, Zhong Y, Zhou P, et al. Perioperative management and treatment for complications during and after peroral endoscopic myotomy (POEM) for esophageal achalasia (EA) (data from 119 cases). Surg Endosc. 2012; 26:3267–3272.

13. Bang Y-S, Park C. Anesthetic consideration for peroral endoscopic myotomy. Clin Endosc. 2019; 52:549–555.

14. Okada T, Izuta S, Mizobuchi S. A case of ventilatory impairment during per-oral endoscopic myotomy under general anesthesia. JA Clin Rep. 2018; 4:23.

15. Kiriyama S, Naitoh H, Kuwano H. Propofol sedation during endoscopic treatment for early gastric cancer compared to midazolam. World J Gastroenterol. 2014; 20:11985–11990.

16. Song BG, Min YW, Cha RR, et al. Endoscopic submucosal dissection under general anesthesia for superficial esophageal squamous cell carcinoma is associated with better clinical outcomes. BMC Gastroenterol. 2018; 18:80.

17. Goudra B, Singh PM. ERCP: the unresolved question of endotracheal intubation. Dig Dis Sci. 2014; 59:513–519.

18. Basavana G. Goudra, Michael Duggan, Vidya Chidambaran, et al. Anesthesiology: a practical approach. New York (NY): Springer;2018.

19. Hauser G, Milosevic M, Zelić M, Stimac D. Sudden death after endoscopic retrograde cholangiopancreatography (ERCP)--case report and literature review. Medicine (Baltimore). 2014; 93:e235.

20. Wanderer JP, Nathan N. Bubble trouble: venous air embolism in endoscopic retrograde cholangiopancreatography. Anesth Analg. 2018; 127:324.

21. Marchesi M, Battistini A, Pellegrinelli M, Gentile G, Zoja R. Fatal air embolism during endoscopic retrograde cholangiopancreatography (ERCP): an “impossible” diagnosis for the forensic pathologist. Med Sci Law. 2016; 56:70–73.

22. Mathew J, Parker C, Wang J. Pulseless electrical activity arrest due to air embolism during endoscopic retrograde cholangiopancreatography: a case report and review of the literature. BMJ Open Gastroenterol. 2015; 2:e000046.

23. Wills-Sanin B, Cárdenas YR, Polanco L, Rivero O, Suarez S, Buitrago AF. Air embolism after endoscopic retrograde cholangiopancreatography in a patient with Budd Chiari syndrome. Case Rep Crit Care. 2014; 2014:205081.

24. Lanke G, Adler DG. Gas embolism during endoscopic retrograde cholangiopancreatography: diagnosis and management. Ann Gastroenterol. 2019; 32:156–167.

25. Fang Y, Wu J, Wang F, Cheng L, Lu Y, Cao X. Air embolism during upper endoscopy: a case report. Clin Endosc. 2019; 52:365–368.

26. Donepudi S, Chavalitdhamrong D, Pu L, Draganov PV. Air embolism complicating gastrointestinal endoscopy: a systematic review. World J Gastrointest Endosc. 2013; 5:359–365.

27. Thompson CC, Kumar N, Slattery J, et al. A standardized method for endoscopic necrosectomy improves complication and mortality rates. Pancreatology. 2016; 16:66–72.

28. Goudra BG, Singh PM, Gouda G, et al. Safety of non-anesthesia provider-administered propofol (NAAP) sedation in advanced gastrointestinal endoscopic procedures: comparative meta-analysis of pooled results. Dig Dis Sci. 2015; 60:2612–2627.