colonoscopy and anesthesiology? other needs for anesthesiologists?

[ThinkFast007]

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Out of curiosity...

When colonoscopies are performed by gastroenterologists (not by Colo-Rectal Surgeons) is an anesthesiologist present? I've never actually seen a colonoscopy so I'm not really sure how it's done...i know you put a scope up the A-hole (i just remember doing a question or something where they said anesthesia is required).

secondly, given the anesthesiologists savvy with injections/needles, the whole nine yards......have any of them ventured into the field of botox etc?? 🙄

 

[UTSouthwestern]

Out of curiosity...

When colonoscopies are performed by gastroenterologists (not by Colo-Rectal Surgeons) is an anesthesiologist present? I've never actually seen a colonoscopy so I'm not really sure how it's done...i know you put a scope up the A-hole (i just remember doing a question or something where they said anesthesia is required).

secondly, given the anesthesiologists savvy with injections/needles, the whole nine yards......have any of them ventured into the field of botox etc?? 🙄

Ideally, an anesthesiologist/anesthetist is present to provide sedation, but GI docs (at least some of the academic ones) are trying to cut costs by going to NAPS (nurse administered propofol sedation). There was a post about this last week if I'm not mistaken.

Some anesthesia providers are charging for general anesthesia for these procedures which is a stretch but can be immensely profitable if you consider a 3 point start plus 1-2 points for time for a 4-5 point case that should only take 15-30 minutes. A really fast endoscopist can do 3-4 scopes an hour and that adds up to 12-20 points per hour of work at rates of $15-60 dollars per point (medicare to private insurance rates). You do the math, but the range could be $180-$1,200/hour, which is why some GI guys are thinking about using NAPS.

Problem is that they had this situation before with nurse administered Versed sedation and that didn't turn out well.

Yes there are anesthesiologists doing botox. One of my former resident classmates if starting up a cosmetic center to do botox, pain management procedures, and cosmetic resurfacing procedures of all kinds.

 

[AJM]

Ideally, an anesthesiologist/anesthetist is present to provide sedation, but GI docs (at least some of the academic ones) are trying to cut costs by going to NAPS (nurse administered propofol sedation). There was a post about this last week if I'm not mistaken.

Interesting. I wasn't aware that there are folks out there who regularly use anesthesiolosists to provide sedation for their endoscopies. At my hospitals, we rarely have anesthesiologists present for our bronchoscopies (kind of like the colo, but smaller scope and different orifice) -- almost all of our sedation is "non-anesthesiologist-delivered moderate sedation". The only times we have an anesthesiologist present are for our rigid bronchs or on our very difficult patients when we have to do the case under general anesthesia. The GI guys here run things much the same way -- they do about 1-2 cases under general anesthesia each day and the other 40 or so are done without an anesthesiologist.

 

[toughlife]

The 100th anniversary brochure from the ASA mentions this issue briefly and it admits that GI docs probably won't heed to the ASA's recommendations of always having a licensed anesthesia provider on site when doing GI procedures.

 

[VentdependenT]

10% ketamine in my propofol drips always does me right...oh yeah and that nystagmis in patients is validation of my efforts.

 

[cytoskelement]

At my university, all the GI docs administer there own sedative for colonoscopies. At the community hospitals that we rotate through, one of the GI docs told me that they absolutely use anes. during colonoscopies and do NOT during flex-sigs. he also implied that it has been tough to get anesthesiologists to fill their large number of colons 2/2 to an "anesthesiologist shortage". so for you guys and gals thinking private practice - Whoomp, there it is! inside-out and up-side down. gonna show you cats what its all about.


ps. anesthesiologists to fill there large number of colons... i couldn't resist.

 

[ThinkFast007]

At my university, all the GI docs administer there own sedative for colonoscopies. At the community hospitals that we rotate through, one of the GI docs told me that they absolutely use anes. during colonoscopies and do NOT during flex-sigs. he also implied that it has been tough to get anesthesiologists to fill their large number of colons 2/2 to an "anesthesiologist shortage". so for you guys and gals thinking private practice - Whoomp, there it is! inside-out and up-side down. gonna show you cats what its all about.


ps. anesthesiologists to fill there large number of colons... i couldn't resist.

yup thats wht i heard too....flex sigs--no need of anesthes...but w/ full colonoscopies they are needed.

i say marry a GI doc !! keep the dough and the colons inside the family