GI Double Preps

[imfrankie]

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Anyone else contending with the GI docs who are claiming "it's okay" to sleep their patient on the day the patient has done part two of these new double prep routines? Forget transparency, can we even really assume that bowel prep goop is a "clear liquid?"

One of my partner's patients got burned when the GI doc coerced my partner into doing a MAC EGD-Colon on the same day as part-two of a prep. He put him off for 4-6 hours--in the face of the GI doc's pleading expertise as to the emptying time, blah-blah--nevertheless it was a boat load of aspirate down the pipe and the patient shipped off to the big house for a few days of vent care.

Anybody know any literature about this yet? I rarely tube GI scope cases (not that the NPO guidelines are predicated on plan for ETT) but am getting pushed to assume these preps qualify as two hour clears.

Thanks in advance for thoughts.

 

[aneftp]

4 hours NPO should be fine.

I've read the literature about the "split preps" when I was at the University Hospital.

GI preps are actually better with "split preps".

http://www.beckersasc.com/gastroent...-solution-more-effective-pre-colonoscopy.html

The real issue is NPO times....that's your concern. I understand that. The literature stated that these split prep patients did not have anymore significantly adverse complications (aspirations) vs. prepping the day before.

Now since Fox News is one of my favorite news stations. I like to be "fair and balance"

Saying all that, I read the study much closer. While they quoted "diverse" patient population, including those with DM, CAD, CHF etc.

The key I looked at was average weight. The average weight of those GI patients was....drums roll.....186 pounds.

Yep. Those GI patients averaged only 186 pounds. That's male and female patients!!

That's like the typical NPO guidelines the ASA originally based on. ASA guidelines were based on 5 foot 10, 150 pound 22 year old medical students in the 1960s. Crazy I know.

So take the split prep NPO times and make them wait at least 4 hours. I don't think you need to wait 6 hours. 6 hours is a light breakfast.

4 hours should be sufficient time. 2 hours NPO is way to risky especially if patients are morbidly obese, or have slow gastric emptying times.

These split preps are becoming or will become the standard soon.
Just wanted to add. I have done macs on plenty of split preps on University patients. They've all done fine.

 

[bostonblaz]

Have been working with two part preps for a few years now both at the Gi center we cover and the hospital. Shouldn't be an issue and hasn't been as these people should be npo of solid food for over 24hrs. Before you go to sleep tonight drink a glass of water and I promise you won't end up in an icu. Blaz

 

[imfrankie]

Have been working with two part preps for a few years now both at the Gi center we cover and the hospital. Shouldn't be an issue and hasn't been as these people should be npo of solid food for over 24hrs. Before you go to sleep tonight drink a glass of water and I promise you won't end up in an icu. Blaz

I ain't worried about a glass of water thirty minutes before a general anesthetic. I'm worried about something that is clear-ly not water--and a fair volume of it. "Never had a problem" isn't what I'm looking for, since I-have-seen-a-problem makes that argument a wash.

 

[pgg]

Have been working with two part preps for a few years now both at the Gi center we cover and the hospital. Shouldn't be an issue and hasn't been as these people should be npo of solid food for over 24hrs. Before you go to sleep tonight drink a glass of water and I promise you won't end up in an icu. Blaz

I ate 1/2 a takeout carton of broccoli beef and chow mein right before bed last night, and I'm still breathing today, but I'm not going to open a Panda Express in the preop area. 🙂

 

[bostonblaz]

First, I run two rooms there twice a week and we do 25 cases in each room so my n is quite large. Second, the prep itself is a small amount of liquid and if you do doubles with the egd first you will find nothing in their stomach unless they didn't follow npo rules or the have some other reason for delayed gastric emptying. Most important people aspirated most commonly when they are light and then stimulated. Is that better? Blaz