Regurgitation during colonoscopy

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Timeoutofmind

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59yo F
BMI 27
Appropriately NPO

Screening colonoscopy with very quick and good endoscopist in an ASC

Just giving straight propofol, and she is in lateral position

5 minutes in starts coughing and regurgitates a mouthful of greenish fluid.

I suction it.

Sats unchanged. Breathing comfortably, no more coughing.

I just finished the case and watched her clinically and she did fine.

Would anyone have:

Turned the sedation off?
Intubated?
CXR?
Admitted for observation overnight?

Wanted to get some thoughts from the group.

Thanks!

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Sedation off and let the gastroenterologist know.
cxr no because it won't change your management and you may not see anything yet anyway.
Admit no but watch her in pacu for a while.
 
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Also tell the patient, and instruct her to go to the ER if becoming short of breath at home (i.e. serious aspiration pneumonitis, unlikely).

You haven't done anything wrong. People make and regurgitate bile, even when NPO, especially if nervous. It can even give a form of GERD/esophagitis.

I wouldn't have turned off sedation, unless the patient had been too deep to protect her airway. Sounds like she wasn't.
 
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The fact that she was coughing is a good thing. That means her airway reflexes were at least somewhat intact. I would be more concerned if I saw gastric contents coming out of the mouth and she wasn't coughing.

As said above, CXR in the PACU because you want to CYA, not because it will show anything that acutely. Watch her for a couple hours in PACU and monitor sats and symptoms. Instruct to return to ED if SOB.
 
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Why CXR in PACU if stable?

It shows nothing = chemical pneumonitis.
It shows something = chemical pneumonitis.

Either way you're doing nothing. Observe for a couple of hours in PACU and ensure no new O2 requirement. If O2 requirement --> admit for observation for resolution vs. progression to pneumonia.
 
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No
No
No
No

CXR only if I believe it was significant and want to get baseline. I agree w/ if O2 requirement then observation.

I might be on my own with this but sometimes continuing with the case gives you time to treat the patient. For instance, I got called to the OR b/c they had MAC case with regurgitation of green fluid and coughing. They intubated. They wanted to cancel the case. Fairly good VS's. I continued the case so I could suction and treat the patient better than what I feel they would get in the PACU. (Obviously stop if patient looks like they will or are deteriorating.)
 
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