Aspiration risk with EGD?

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that’s easy. AFOI.

The challenge is achalasia on a mediocre looking airway with no prior anesthesia.

I toyally agree with your plan, but Therein lies a point. You have to topicalize the airway to do afoi. This puts the patient at risk for aspiration

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It is a real thing, however presence of an anesthesia machine does not make it an OR, they can still be classified as procedure rooms.
Some places have a lot more rules than others, try working at a “for profit physician owned” hospital. Super strict regulations that all you people at non profit places don’t have to consider. However, they can still be a great place to work.
 
Just get an ICU vent and a prop pump. Don’t an actual “anesthesia machine” to intbate and do a GA.
 
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