turnupthevapor

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I am a new attending....We are in a big center so our endo guys bring down some sicko patients.

My question is about full stomach patients.... GI bleed, Achalasia, Esophageal CA (full esophagus more than full stomach), old fat DM pts, etc.....what do you do with these guys. Our endo rooms DO NOT have anesthesia machines. If I want to RSI I would have to bring the case to main OR and screw up everones schedule.

On one hand I want to uphold the same standards as I do in the main OR, on the other hand I know as soon as he or she goes down the goose they will suction out what ever is there!

What do you all do?
 
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zippy2u

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Use the white gun they call propofol; ya can't walk on eggshells your whole life, Slick. Regards, -----Zippy
 

coprolalia

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Yes, my standards are compromised in endo. I hate going there. And, I'm only a CA-3.

I wish they'd just get rid of the propofol labeling thing. Let the GI docs kill a few dozen people pushing it themselves and getting into a situation they can't get out of. And, forget about the cush reimbursement we get for being there. Aetna had it right. Versed and Demerol are just fine for the vast majority of people. Me? Do mine completely awake. If the patient needs anesthesia - truly needs anesthesia - then be prepared to have all the accoutrements present that the anesthesiologist needs. Far too many practices make far too much money milking the system with the milk of amnesia. What we do in endo is not "anesthesiology".

There, I said it.

-copro
 
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nutmegs

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Yes, my standards are compromised in endo. I hate going there. And, I'm only a CA-3.

I wish they'd just get rid of the propofol labeling thing. Let the GI docs kill a few dozen people pushing it themselves and getting into a situation they can't get out of. And, forget about the cush reimbursement we get for being there. Aetna had it right. Versed and Demerol are just fine for the vast majority of people. Me? Do mine completely awake. If the patient needs anesthesia - truly needs anesthesia - then be prepared to have all the accoutrements present that the anesthesiologist needs. Far too many practices make far too much money milking the system with the milk of amnesia. What we do in endo is not "anesthesiology".

There, I said it.

-copro
so when you're assigned there, your patients just get versed/demerol, right?
 

Planktonmd

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Life in the real world (non academia world) is not either black or white, it's some shade of gray most of the times.
Your job is to get things done and to make money in the process, your job is to get the cases going not to find reasons to cancel them (that's what you do in academia).
If the only Endo's you are doing are the very sick ones that are likely to have complications then I say do not compromise your standards and deal with them as you deal with any OR case.
On the other hand if you are doing a large number of endos and making good money you need to be flexible.
 
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coprolalia

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so when you're assigned there, your patients just get versed/demerol, right?
Hell no. I push the white stuff, chart it as a "general anesthetic", and get paid 1/20th of what I make for the department on those days. I know what hole to stick the tube in, if need be, and feel confident that I can do it with a high degree of certitude.

-copro
 
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maceo

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I am a new attending....We are in a big center so our endo guys bring down some sicko patients.

My question is about full stomach patients.... GI bleed, Achalasia, Esophageal CA (full esophagus more than full stomach), old fat DM pts, etc.....what do you do with these guys. Our endo rooms DO NOT have anesthesia machines. If I want to RSI I would have to bring the case to main OR and screw up everones schedule.

On one hand I want to uphold the same standards as I do in the main OR, on the other hand I know as soon as he or she goes down the goose they will suction out what ever is there!

What do you all do?
why would you need a anesthesia machine to do a rapid sequence. If you have to intubate.. do it.. in the endo suite. get the nurse to help you. bag them and give some diprivan. to keep them asleep. If you dont feel comfortable.. tube them.. or tell the gi doc to post his case in the or.
 

huktonfonix

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why would you need a anesthesia machine to do a rapid sequence. If you have to intubate.. do it.. in the endo suite. get the nurse to help you. bag them and give some diprivan. to keep them asleep. If you dont feel comfortable.. tube them.. or tell the gi doc to post his case in the or.
Agreed. Think of it as a floor code. MSMAID (or whatever pneumonic you use) still applies. However a machine only exists to deliver the anesthetic which is unneccesary in a code. The rest of the ventilatory function is just as easily accomplished with an ambubag and O2 source. suction, monitors, airway equipment, etc... are still essential though.
 

bubalus

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Our GI lab has a machine and monitors the same as our ORs. I make no compromises. If I'm involved, it's because the GI wants general.
 
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