Private Practice Advice

[sbmed100]

First year out as a PP attending in a mid-size community hospital. We do a fair amount of sedation for GI endo procedures (colonoscopies, upper endoscopies (EGD), esophageal ultrasound, etc.) We provide anesthesia primarily in the endo suite, though are frequently asked to go to the ER and ICUs.

What do you Private Practice guys do when asked to provide anesthesia for 1) upper endoscopies to evaluate for probable bleeding ulcer in a stable patient and 2) to dislodge food stuck in the esophagus in a patient in the ER?

There is a TREMENDOUS pressure to do these cases as IV sedation cases (i.e. propofol usually, midaz + ketamine as an alternative) rather than taking them to the OR where a whole nursing/surgical tech team has to be called in.

What do you guys do?

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[jetproppilot]

What do you Private Practice guys do when asked to provide anesthesia for 1) upper endoscopies to evaluate for probable bleeding ulcer in a stable patient and 2) to dislodge food stuck in the esophagus in a patient in the ER?


What do you guys do?

For 1), propofol only.

Have never been called to the ER to provide anesthesia for food stuck in the esophagus.....does your GI dude bring all his s hit (and his helper) down to the ER and scope down there?

Never seen that.

 

[Noyac]

First year out as a PP attending in a mid-size community hospital. We do a fair amount of sedation for GI endo procedures (colonoscopies, upper endoscopies (EGD), esophageal ultrasound, etc.) We provide anesthesia primarily in the endo suite, though are frequently asked to go to the ER and ICUs.

What do you Private Practice guys do when asked to provide anesthesia for 1) upper endoscopies to evaluate for probable bleeding ulcer in a stable patient and 2) to dislodge food stuck in the esophagus in a patient in the ER?

There is a TREMENDOUS pressure to do these cases as IV sedation cases (i.e. propofol usually, midaz + ketamine as an alternative) rather than taking them to the OR where a whole nursing/surgical tech team has to be called in.

What do you guys do?

If I get called on an emergent basis, they get a tube.

If scheduled then sedation usually.

But there are no hard and fast rules here. Use your training and skills as you see fit.

 

[core0]

For 1), propofol only.

Have never been called to the ER to provide anesthesia for food stuck in the esophagus.....does your GI dude bring all his s hit (and his helper) down to the ER and scope down there?

Never seen that.

Thats what we used to do. The GI nurse would come in and bring the mobile cart to the ER. Then the GI doc would sedate there and take out the food bolus. Usually the ER would give them Glucagon and that passed a lot of food impactions. It works OK since the ER can usually recover the patient. The only time we had a problem was when a guy tried to Heimlich himself by throwing himself at a counter to get out a stuck hot dog. The doc took out the hot dog and then went back down to look. The subQ air and beautiful view of the mediasteinum necessitated and urgent call to thoracic surgery.

When I did peds GI the doc would take them to the OR and they would get the whole nine yards. At least kids swallow more interesting things than adults.

The only time that we used anesthesia was for ERCP's, EUS and "special requests". No payment for routine cases. In theory the ER docs could sedate with Propofol but our docs were more comfortable with fent/versed. Usually for ERCPs anesthesia would tube. For EUS and "special requests" they seemed to prefer propofol (usually the special request was for propofol).

David Carpenter, PA-C