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A question for the group: who feels it's safe to perform sedation for EGD for stuck food bolus, versus mandating GETA from the outset? A current topic of debate in my department. Thanks.
EGD for stuck food bolus
- Thread starter Monty Python
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Most of ours are GETA. Our current group of GI guys break up the food and push it DOWN into the stomach. Supposedly there are potential issues with esophageal tears with trying to pull a large chunk back up and out. That means its a longer procedure with more potential for A/W issues, so GETA with RSI is easier and safer.
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Up front disclaimer: I'm not a physician (yet), so I'm not here to offer an opinion about safety of procedures/techniques...so please take my post as such. Just wanted to humbly offer my anecdotal experience of upper GI food bolus treatment in community, for-profit facilities. I know there are people here with experience primarily (or exclusively) in academia.
In the facilities I have worked in, the anesthesiologist isn't bothered. The GI doc comes in, along with his GI lab nurse, and the GI tech. +/- an ED nurse and me in the room. Nurse gives topical anesthesia, Versed/Fentanyl, GI doc visualizes the food and pushes it down into the stomach. ED nurse recovers the patient.
This has been my experience with a couple of different community EDs over the last 5 years. I would imagine that larger, academic facilities do things differently. And no, I don't work in BFE...but in a large, metro area.
I hope to participate in these discussions in a more advanced manner in the years to come. In the meantime, the anesthesiology forum will continue to be a good place to come to read about cool cases, have a laugh, and fire political fodder.
In the facilities I have worked in, the anesthesiologist isn't bothered. The GI doc comes in, along with his GI lab nurse, and the GI tech. +/- an ED nurse and me in the room. Nurse gives topical anesthesia, Versed/Fentanyl, GI doc visualizes the food and pushes it down into the stomach. ED nurse recovers the patient.
This has been my experience with a couple of different community EDs over the last 5 years. I would imagine that larger, academic facilities do things differently. And no, I don't work in BFE...but in a large, metro area.
I hope to participate in these discussions in a more advanced manner in the years to come. In the meantime, the anesthesiology forum will continue to be a good place to come to read about cool cases, have a laugh, and fire political fodder.
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The way i look at is: if there's food stuck in the esophagus and i'm gonna be giving any kind of drug, the patient hasn't been NPO and that mandates an ETT via RSI+cricoid regardless of how "simple" the procedure is perceived to be.
