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Anesthesia for Therapeutic Endoscopy Anesthesia for Anesthesia for Therapeutic Therapeutic Endoscopy Endoscopy T. T. Akaraviputh Akaraviputh , MD , MD . . Department of Surgery Department of Surgery Faculty of Medicine Faculty of Medicine Siriraj Siriraj Hospital Hospital Mahidol Mahidol University University “Save and safe in the therapeutic endoscopy” July 11 th, 2008

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Page 1: Anesthesia for Therapeutic Endoscopythaitage.org/source/content-file/content-file-id-3.pdfAnesthesia for Therapeutic Endoscopy Anesthesia for Therapeutic Therapeutic Endoscopy T. Akaraviputh,

Anesthesia for Therapeutic Endoscopy

Anesthesia for Anesthesia for Therapeutic Therapeutic EndoscopyEndoscopy

T. T. AkaraviputhAkaraviputh, MD, MD..Department of SurgeryDepartment of Surgery

Faculty of Medicine Faculty of Medicine SirirajSiriraj

Hospital Hospital MahidolMahidol

UniversityUniversity

“Save and safe in the therapeutic endoscopy”July 11th,

2008

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Anesthesia for Therapeutic Endoscopy

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Anesthesia for Therapeutic Endoscopy

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Consideration

- Position- Airway sharing- Out/Inpatient

- Underlying disease- Urgency

- Course of disease1. Patient

2. Procedure

3. Operating theatre (outside OR?)

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Course of disease

- Progression- Nutrition- Volume status- Organ involvement

Underlying disease

- DM, HT, IHD, etc.

Urgency

- Elective or emergency------ FULL STOMACH?

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Anesthesia 2002

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Place

-Availability and system management-Operating team-Supporting team (CPR!)

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“Routine monitoring of the patients pulse rate, blood pressure, oxygen saturation are useful in identifying early problems. (B) Monitoring of EKG recordings may be helpful in selected cases.(C) Capnography, measurement of carbon dioxide retention, may be useful in prolonged cases. (A)”

Guidelines for conscious sedation andmonitoring during gastrointestinal endoscopy(ASGE 2003)

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Intervention Room

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Choice of anesthesia

1.MAC / TIVA(Monitored anesthesia care +/- sedation)

2.General anesthesia

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Level of sedation

1.Conscious sedation(airway reflex intact and cooperation)

2. Deep sedation

3. General anesthesia

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Definition of General Anesthesia and Levels of Sedation/Analgesia

Anesthesia 2002

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Drug of choice:

1. Narcotic ------ Fentanyl

2. Benzodiazepine ----- Midazolam

3. IV anesthetic ----- Propofol, Ketamine

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Propofol structure•

2,6-Diisopropylphenol

“Milk of Amnesia”•

“Milk of Anesthesiologists”

“Penguin Milk”

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Propofol (2,6-diisopropylphenol)•

The IV

anesthetic of choice for ambulatory

surgery in outpatients.•

It is extensively metabolized in the urine.

Favorable operating conditions and rapid recovery

Relatively high incidence of apnea,

and blood pressure reductions

Antiepileptic and anxiolytic properties•

Anticonvulsant and anticonflict effects,

but

not sedative-hypnotic and anesthetic properties.

Pain on injection and anaphylactoid reactions

Curr

Med Chem. 2000

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In conclusion,

propofol sedation during diagnostic and therapeutic ERCP is more effective than midazolam/meperidine sedation and can be administered safely under adequate patient monitoring even in elderly high-risk patients.

Am J Gastroenterol 2005

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Endoscopy 07

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Anesthesia 2002

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Position

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In conclusion,

we believe that ERCP can be safely and effectively performed with the patient in the supine position.

However,

it

should be reserved for specific indications,

for institutions that can offer special support for these cases,

especially for patients who are

not intubated.

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ERCP in prone position

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Prone position

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Supine position

Anal route

Oral route

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Imaging Quality

Lt lateral position

Supine position

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From 1999 to 2003 in Siriraj Hospital. RESULTS: There were 2,144 patients during

study period.The age group of 50-69 years was the highest one (46.9%).

The most frequent anesthetic complication was hypotension.

Amornyotin S. J Med Assoc Thai. 2004

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ERCP Training

Nakornsritamarat workshop Lampang workshop

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