Colonoscopy in OR prior to Open Case

[BobLoblaw78]

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I have mostly seen colonoscopy prior to surgery be performed in Endoscopy followed by trip to surgery then caes. That makes less sense to me. I believe there is more risk from a patient being sedated for a colonscopy, recovered, taken to OR, induction, general anesthesia, then proceed with open abdominal case VS taken to OR, induction, general anesthesia, colonoscopy, open abdominal case. Concerns are anesthetic VS surgical infection risk.

Obviously there is insufficient studies and data. I argue that risk is minimal with proper precautions. Risk of anesthesia is minimal unless the patient is very sick and in that case I think it would be worth insisting on doing both in the OR to minimize anesthesia duration and risk.

What do you think?

 

[nimbus]

Most of the time, patients are referred for surgery after a diagnosis is made by GI. Are your patients getting a second colonoscopy immediately prior to surgery?

 

[BobLoblaw78]

Not usually. It has happened a couple times per year for different reasons. Not a big thing, it just got me to wondering what other places did.

The most recent one had obstructive mass (apparently not) that was done over a month prior to scheduled surgery by another provider that could not complete the exam due to the mass. Patient had respiratory issues and was scheduled for colectomy.

Other times it has been for convenience of two procedures in one day. I don't like sedation, wake up, general. Seems like double the risk or more. If I was the patient, I would take increased risk of infection (if any) over double anesthesia.

 

[nimbus]

Not usually. It has happened a couple times per year for different reasons. Not a big thing, it just got me to wondering what other places did.

The most recent one had obstructive mass (apparently not) that was done over a month prior to scheduled surgery by another provider that could not complete the exam due to the mass. Patient had respiratory issues and was scheduled for colectomy.

Other times it has been for convenience of two procedures in one day. I don't like sedation, wake up, general. Seems like double the risk or more. If I was the patient, I would take increased risk of infection (if any) over double anesthesia.

Agree it’s better for patient to have one anesthetic. OTOH, your group will get more revenues if they are done separately.

 

[Noyac]

Why are you recovering them btw co,lonoscopy and surgery?

 

[vector2]

This has happened to me once since I've been staff. We coordinated with the GI suite and the OR to roll to endo as the previous case in the OR was finishing up. Tubed pt in endo, prop gtt, finished the scope, kept them intubated and then transported to the OR once it was turned over.

 

[BobLoblaw78]

Why are you recovering them btw co,lonoscopy and surgery?

Taking the patient to the OR, time for setup in OR, start induction. Not a full recovery, but don't continue giving sedation when not required for the 30 minutes in between. Usually the patient is borderline awake at end of colonoscopy and feel it is safer to stop sedation versus continued sedation.

 

[jwk]

If they know ahead of time they're doing the colonoscopy and definitely doing an open case immediately following, do the colonoscopy under GA in the OR. I assume most GI units have portable setups on carts.

 

[deleted162650]

I see no medical reason not to do the colo in the OR under GA immediately followed by the belly case. It’s no dirtier than doing any other large bowel anastamosis case on a prepped colon. I don’t think I’d want to a colo in the OR followed by a non-belly case though.