Anesthesia and airway management for gastrointestinal endoscopic procedures outside the operating room.

PURPOSE OF REVIEW: To review the anesthestic and airway management for gastrointestinal procedures outside of the operating room. RECENT FINDINGS: The number of gastrointestinal endoscopic procedures performed is steadily increasing worldwide. As complexity, duration and invasiveness of procedures increase, there is ever greater requirement for deeper sedation or general anesthesia. A close relationship between anesthetic practitioners and endoscopists is required to ensure safe and successful outcomes. The American Society of Gastrointestinal endoscopy and the British Society of Gastroenterology have recently released guidelines for sedation and general anesthesia in gastrointestinal endoscopy, highlighting the need for careful monitoring for all cases, and anesthetic expertise in complex cases. The recent advances in high-flow nasal oxygenation in sedation may provide alternative options for oxygenation during gastrointestinal sedation, especially in deep sedation and this may reduce the need for general anesthesia. SUMMARY: The advances in gastrointestinal endoscopic intervention have increased the requirement for deep sedation and anesthetic involvement outside of the operating room. Careful titration of anesthetic intervention and close monitoring are required to ensure patient safety.

Pseudomonas Aeruginosa Bacteraemia in Two UK District Hospitals.

Pseudomonas aeruginosa bacteraemia is associated with significant morbidity and mortality. We retrospectively studied the epidemiology of bacteraemia due to P. aeruginosa in two UK district hospitals so as to determine prevention strategies and assess the efficacy and compliance with local hospital antibiotic guidelines. Eighty six episodes occurred in 85 patients over the 3 year period. There was a year on year increase in bacteraemias, due predominantly to an increased proportion of community-onset episodes. Urinary catheterisation was a significant risk factor, along with anaemia, renal disease, malignancy and diabetes. The antibiotic guidelines were adequate for 92.8% of episodes but only 73.8% of patients received adequate therapy. Failure to follow the guidelines was principally due to unwillingness to use gentamicin due to concerns about nephrotoxicity. The antibiotic guidelines may need reviewing to accommodate this problem and further work is required to address urinary catheter care in both the hospital and community. Pseudomonas aeruginosa should be considered a significant pathogen when patients are admitted with features of sepsis.