Peds in Outpatient GI suites

[Tee Cell]

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Curious as to what is being done out there. I only do peds endo in hospital settings. Never did anyone under 18 in outpatient endoscopy suites. What is the youngest age you would do peds GI in an outpatient setting?

 

[imfrankie]

young

 

[IlDestriero]

6 months.

 

[aneftp]

Standalone GI outpatient center for peds? Or multi specialty center?

I haven't heard of stand a lone gi centers doing peds gi cases.

 

[jwk]

Standalone GI outpatient center for peds? Or multi specialty center?

I haven't heard of stand a lone gi centers doing peds gi cases.

I assume we would do them in our ASC's - we do peds all the time.

We would never do them in our stand-alone GI-only units.

 

[HalO'Thane]

I assume we would do them in our ASC's - we do peds all the time.

We would never do them in our stand-alone GI-only units.

Are you guys doing GA or MAC for your pediatric patients? If doing MAC, how young are the patients before you are uncomfortable doing the case without an LMA or ETT?

 

[IlDestriero]

Let's be honest, a MAC GI scope in a kid is a room air General with an unsecured airway.
I tube them below 10kg, usually.
Lately I'm doing mostly LMAs.

 

[btbam]

Tube for all EGDs, LMA for colonoscopies...Having to setup IVs/airway stuff/etc for 10-12 EGDs makes for a 😱 day.

 

[imfrankie]

If they've got an IV I put a hundred of remi in a 60 cc syringe of propofol and run per usual. Scope goes through hole in a simple mask. If they are smaller than a bigger kid I use a deflated LMA prolly like IlD.
If no IV, I mask them lullabye-bye and LMA typically. Haven't tubed a kid in a long while for an EGD, but mostly do outpatient kids now.

 

[dhb]

How do they pass the EGD scope with an LMA?

 

[HalO'Thane]

How do they pass the EGD scope with an LMA?

It's usually not that hard. Similar to passing a TEE they just glide the scope over the roof of the mouth. There is an initial resistance getting past the LMA but after that it passes easily. If the GI doc is struggling you can always deflate the cuff of the LMA first, allow them to pass the scope, and then re-inflate the cuff.

 

[IlDestriero]

There's nothing to it at all, if anything, it's easier for them to get into the esophagus as the LMA just guides it right in. A little extra lube and don't over inflate the LMA.