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Tibetan Farmers - photo by JoAnn Sturman
Scott Sturman MD
For cases with intense stimulation where the surgeon begins and finishes quickly, the drugs used for anesthesia and the method in which they are delivered must match the pace of the case.
When entering the endoscopy suite, a propofol infusion pump often rests next to the anesthesia machine. However, most private practice endoscopists are so fast at performing colonoscopies and EGDs that manual administration of propofol allows for quicker response time to varying levels of patient stimulation.
Connect the propofol syringe with an extension tubing to the injection port closest to the patient and run the IV at a sufficient rate that there is virtually no lag time between syringe and vein. With a thumb on the plunger, continually talk to the patient to gauge the level of responsiveness and insure the state of consciousness hovers just below the sleep threshold.
Propofol alone will suffice in some patients, but for others, particularly the younger cohort or those who take chronic pain medication, the stimulation will prove too much. In these cases patients benefit from a baseline narcotic load. Alfentanil 500-1000 ug given immediately upon entrance to the endoscopy suite is ideal, since its effects are rapid and the half life short enough not to interfere with prompt discharge from recovery room.
