Urzuz, your thinking was very similar to mine. I probably could do a propofol MAC on this dude, with the its attendant desatting / patient moving / hypoventilation, but was never strongly considering doing so in this out of OR setting, with some-to-no help, a sick patient, and an unknown procedure.
Here's what happened.
Attempts at radial art line x4 failed. Pt hyperesthetic, wouldn't hold still, and I simply had no mojo. So I bailed.
Preox'ed in 30 degrees head of bed up position (lowest pt would tolerate), started induction with 1 unit vasopressin then 0.1 mg/kg etomidate then 0.5 mg/kg propofol then 1 mg/kg sux. Easy glidescope, no sign of blood or aspiration in hypopharynx. Desatted a tiny bit (95%) despite the preox. Controlled ventilation with etCO2 in mid 30s. Maintained with 1% sevo in oxygen (no air available) and a little propofol gtt. BP stays stable.
GI pops scope in and VOILA! ... there's just some erosive gastritis, mild portal HTN gastropathy, one small varix. Pretty unexciting. They poke around for 10-15 minutes just to make sure. Gave another unit of vasopressin to keep BP stone cold normal. Still A-fibbing away at 130's.
At some point he went into a rapid SVT at 195. Cycled BP but it had self terminated by the time the BP finished. I reached for my drawn-up esmolol, and called for adenosine while the cuff was running...on this floor adenosine is only in the crash cart 😕 .
Pt emerged thrashing and dysphoric...big surprise. Fairly juicy but easily suctioned. Extubated to a nonrebreather. Barely maintaining sats in high 80's, sitting up. Held 10cm CPAP on him for a minute or so, figuring he was very atelectatic, that got sats up to high 90's until he was awake enough to cough and deep breathe.
Had a nice chat with the hospitalist about procedure and dispo.
