Anaesthesia for Gastroscopy

# 1 Gastroscopy

Conduct pre-anaesthetic assessment

(Note: the following technique does not apply to patients at higher risk of regurgitation)

Attach monitoring:  NIBP and oximetry (also ECG if indicated).

Obtain IV access

Administer midazolam 1 – 2.5mg (lower end of the range for frail, elderly etc, higher for younger fitter patients).

Spray throat with nebulised lignocaine (Optional)

Insert scope protector between teeth before patient becomes too sedated.

Give propofol bolus 60 – 150 mg (as for midazolam).

The anaesthesia assistant maintains the patient’s airway from the head of the bed (under close supervision from anaesthetist.

Propofol boluses 20 – 50 mg given if patient starts to respond, or after 3-4 minutes have elapsed depending on clinical factors (eg patient reactivity, respiratory rate and depth, HR, BP)

The patient’s vital signs are monitored and recorded throughout the procedure.

Comment 1
I don't use any drugs apart from propofol. Midazolam may take a few minutes to work and varies for a given dose from no response to an apnoeic patient. Fentanyl may produce apnoea. You can assess the effects of a propofol dose faster, and if your dose is too great it wears off quickly.

Comment 2
I find it works well to give approximately 40 mg of propofol as soon as I have established IV access. I find it better to continue boluses around this size to get the patient deep enough to allow the passage of the scope into the oesophagus. Giving larger boluses than this risks making the patient apnoeic. Once the scope is in the stomach smaller boluses e.g. 20 mg intermittently suffice to keep the patient unconscious.