TYK271
Which of the following IS a good candidate for natural airway sedation?
a) A 10 year-old with a history of TE fistula (repaired) with long-term stricture of the esophagus, requiring endoscopic dilation of the esophagus
b) A 6 month-old asymptomatic infant for colonoscopy and upper endoscopy due to family history of disseminated GI malignancy
c) A 21 month-old for concern for magnet foreign body ingestion for upper endoscopy
d) A 14 year-old with history of recurrent nausea and vomiting for upper endoscopy and colonoscopy
e) None of the above
Answer
Answer e. Individual patient factors, surgeon preference, anesthesiologist preference, and venue characteristics should all weigh in to the decision to intubate the trachea or not for GI endoscopy surgery. Patients with protracted vomiting, esophageal stricture or active foreign bodies are at increased risk of aspiration events and this risk is at least partially decreased by endotracheal intubation. Small infants (as in patient B) are at risk for tracheal compression during upper endoscopy and maintenance of a patent airway is also very challenging during these procedures in infants; the conservative management strategy is to secure the airway for this patient.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.