Endoscopy

I was assigned to provide anesthesia in the endoscopy suite one day. Initially, I was relieved; after all, how bad could endoscopy be? Upper endoscopy, colonoscopy, and ERCPs shouldn't take too long and they weren't high risk procedures. Little did I know. In 95% of cases, endoscopies are done under conscious sedation supervised by the gastroenterologist; the anesthesiologist doesn't hear about them at all. They only call us if things are really tough. One of my endoscopies was for a woman with metastatic pancreatic cancer, congestive heart failure, oxygen-dependent chronic obstructive pulmonary disease, and renal failure. Managing her airway, fluids, and medications was definitely a challenge. Two of my patients had neurologic defects so they could not follow commands; we treated one like a pediatric patient, doing an inhaled induction and mask-ventilating until we could get an IV in place, then finishing the induction with IV anesthetics. One patient had a congenital defect and did not have forearms; of course, the anesthesiologist is given the responsibility of obtaining venous access. Lastly, I did not recognize how difficult "out-of-OR" anesthetics are; our equipment isn't the same, we are far away from additional help, and even our anesthesia techs who get our supplies are a ways away. It felt pretty isolated, and subsequently, a little scary providing general anesthetics in the basement of the hospital.

Image of an endoscopist is in the public domain, from Wikipedia.