S/p Heller

[caligas]

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Patient s/p Heller and Nissen for achalasia, for screening colonoscopy with propofol sedation. Reflux controlled and swallows fine.

Concerned at all?

 

[pgg]

Yes, tube, next.

 

[Psai]

I never believe them anymore when they say they swallow fine

 

[deleted162650]

swallows fine.

She single?

 

[Robotic Wis-Hipple]

Yes, tube, next.

Yup, at the very least prove to me prior post surgical scopes were flawless. But then why the need for the scope....

 

[caligas]

Yup, at the very least prove to me prior post surgical scopes were flawless. But then why the need for the scope....

Even with a day of clear liquid diet?

 

[anbuitachi]

Concerned? No. It's a screening colon. Maybe patient is old . Just prop sedation her

 

[pgg]

Even with a day of clear liquid diet?

Yes

GETA isn't quite as efficient as a propofol MAC, but it doesn't add that much time. Presumably achalasia patients are uncommon so this would be a rare bit of inefficiency.

We talked about this a few months ago. Very old thread bumped for a revisit in Jan 2018.

Aspiration risk with EGD?

 

[caligas]

Ok, so I posted and then just ignored everyone’s advice, did the propofol Mac. The guy was just so adamant that his symptoms were gone, including reflux and dysphasia. Better to be lucky than good, (but not really).

 

[nimbus]

Ok, so I posted and then just ignored everyone’s advice, did the propofol Mac. The guy was just so adamant that his symptoms were gone, including reflux and dysphasia. Better to be lucky than good, (but not really).

How did his esophagus look? Was there a huge column of food?

Edit...oops nvm....forgot it was colonoscopy.

 

[caligas]

How did his esophagus look? Was there a huge column of food?

This was just a colonoscopy, so I remain blissfully unaware of that column of food.

I wonder if a chest x Ray would be a good tool to rule out anything sitting in the esophagus.

 

[Psai]

How did his esophagus look? Was there a huge column of food?

Edit...oops nvm....forgot it was colonoscopy.

I've seen them do a transgastric appy so I figure going the other way may not be out of the question in the near future.

 

[HalO'Thane]

This was just a colonoscopy, so I remain blissfully unaware of that column of food.

I wonder if a chest x Ray would be a good tool to rule out anything sitting in the esophagus.

I believe most of these patients get regular follow-ups with a barium swallow. That should give you pretty good information if a recent one is available. I remember the last barium swallow that I reviewed prior to anesthetizing a patient for a Heller Myotomy it looked like a giant bucket of contrast was sitting in his chest all the way up to his oropharynx. That’s when I knew not to take induction on those patients lightly.

 

[caligas]

I believe most of these patients get regular follow-ups with a barium swallow. That should give you pretty good information if a recent one is available. I remember the last barium swallow that I reviewed prior to anesthetizing a patient for a Heller Myotomy it looked like a giant bucket of contrast was sitting in his chest all the way up to his oropharynx. That’s when I knew not to take induction on those patients lightly.

Just had a barium at discharge after Heller several years ago, showed delayed emptying of contrast, but that seems to imply at least eventual emptying?

 

[deleted171991]

Ok, so I posted and then just ignored everyone’s advice, did the propofol Mac. The guy was just so adamant that his symptoms were gone, including reflux and dysphasia. Better to be lucky than good, (but not really).

Yeah, please tell that to his family after he dies from aspirating. 😉

That right there is the problem with the American malpractice system. Anywhere else in the world, if you explain the risks to the patient and he is so stupid that he takes them, it's his fault. In America, it's the physician's. You are not supposed to agree to a plan of treatment just because the patient likes it, if it's inappropriate for the patient to begin with. Especially in an elective situation.

And that's the problem with anesthesia nowadays: we are pushed to be so subservient to the proceduralists and to the patients. Gods forbid you upset somebody by doing your job and delaying a case.

 

[coffeebythelake]

how about you put the patient on their head and see if they regurgitate? The UES contributes minimally to prevent regurgitation.

 

[caligas]

how about you put the patient on their head and see if they regurgitate? The UES contributes minimally to prevent regurgitation.

Interesting idea, worth a try