EGD - Coughing fit

[turnupthevapor]

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Ok so EGD anesthesia is pretty easy but still haven't figured one thing out:

What do you all do when a little secretion ends up in the trachea and the pt is coughing like crazy and the procedure is just starting

Deepen?
Lido?
Lightin them up?
Suction?

I guess the best way to prevent this is to be deep enough as the study starts, right?

My technique is 50 fentanyl while entering the room..... than prop (50 for frail, 80 avg, 110 big guy) try alittle jaw thrust if no reaction I let them start poking and prodding the pt.

 

[foxtrot]

Ok so EGD anesthesia is pretty easy but still haven't figured one thing out:

What do you all do when a little secretion ends up in the trachea and the pt is coughing like crazy and the procedure is just starting

Deepen?
Lido?
Lightin them up?
Suction?

I guess the best way to prevent this is to be deep enough as the study starts, right?

My technique is 50 fentanyl while entering the room..... than prop (50 for frail, 80 avg, 110 big guy) try alittle jaw thrust if no reaction I let them start poking and prodding the pt.

I have used a little Lido to help blunt the cough reflex. Although sometimes it works, and sometimes it doesn't.

 

[seattledoc]

This works great, you should try it.
No fentanyl
Glcopyrollate 0.2mg
Mix Ketamine 25mg, Lidocaine 100mg, Propofol 150mg.
Push the whole stick on big people, less for the little and old people.
Now the whole thing rely's on timing. If you push the drug and then the guy doing the endoscopy decides to make a phone call you're screwed. So my endoscopists know that I want them holding the scope and ready to go. As soon as the propofol starts to work you tell them to go.
Like a charm