Strange Cases

Sometimes as a senior resident, you get unusual assignments. One day on general adult anesthesia, the scheduler asked me to take care of an add-on case. The add-on case was "placement of orogastric tube for upper GI radiologic study under general anesthesia." This in itself was bizarre; these cases almost never require general anesthesia. As I dug deeper, the situation got trickier. The listed location was "GI radiology, end of hallway." I found that we last provided anesthesia in GI radiology over five years ago. After talking to the anesthesia technicians, I managed to get a machine, cart, computer, and medications to the procedure room. I had to contact the radiologist performing the procedure and figure out the story. The patient was a young gentleman who had chronic abdominal pain and nausea ever since childhood. He'd had many abdominal studies and surgeries but no underlying cause was found. After a week of hospitalization with intractable pain and nausea, the GI consult team wanted to look at his peristalsis, the coordination of his digestive tract in moving food along. However, the patient refuses to have placement of a gastric tube while awake due to his severe pain on swallowing. While we considered doing this under sedation, he is at high risk of aspiration and had a high tolerance to opiates and benzodiazepines. Although a little extreme, after a long discussion with the patient, we decided to give him general endotracheal anesthesia for placement of a gastric tube, instillation of contrast, and GI films. The case went very smoothly, but it always bothers me when the anesthetic is more risky than the actual procedure. Nevertheless, we determined that it was the best course of action. I learned quite a bit about working in the hospital system as I navigated the process of getting an unusual case done.