local or general anesthesia

[LuvScrubs2, BSN, RN]

I have a question concerning anesthesia? the patient has a history of PUD, he undergone a endoscopy & the procedure revealed a perforated ulcer & he was sent to the OR for resectioning of the ulcer.

My question is that he had to get an upper gastrointestional endoscopy, which type of anesthesia is used for this procedure local or general? i was thinking local, without the loss of consciouness...

Also, he is going to surgery to get the resectionining of the ulcer, I was thinking for the resectioning that he would receive the general anesthesia because you want elimination of the somatic,autonmic responses such as coughing, vomiting, etc?

I am stuck with which anesthesia to use for both procedures and why? Any assitance is appeciated it....

[Rose_Queen, BSN, MSN, RN]

Chances were that the endoscopy was done with either conscious sedation or monitored anesthesia care (MAC). Conscious sedation is typically versed and demerol given by a trained RN. MAC is given by either an anesthesiologist or CRNA and is usually propofol or similar drug. With conscious sedation, the patient can typically follow commands such as "turn to your left" but will have no memory of the procedure. MAC will have the patient in what is known as "twilight sleep" where they are anesthetized but still able to breathe on their own.

On occasion, endoscopy can be done under local, usually a topical spray for the throat. However, this can be quite uncomfortable for the patient, and most EGDs scheduled where I work are MAC. Very rarely do we see conscious sedation and there are no times that I remember doing uppers with local. Lowers have been done with any of the three choices.

For the surgery, the patient would definitely have had general anesthesia, a combination of inhaled gases, IV drugs, and paralytics. Often, patients having abdominal surgery also get an epidural for postoperative pain management, although since this sounds like it may have been emergent/urgent surgery they may not have done one. Any kind of anticoagulation meds or an increased INR also rule out epidurals.

Hope this helped!

[Daytonite, BSN, RN]

the egd is done under local (conscience sedation) and the surgery will be done under general. you can get information about anesthesia and these procedures here: encyclopedia of surgery http://www.surgeryencyclopedia.com/index.html

• http://www.surgeryencyclopedia.com/a-ce/anesthesia-general.html - general anesthesia
  
• http://www.surgeryencyclopedia.com/a-ce/anesthesia-local.html - local anesthesia
  
• http://www.surgeryencyclopedia.com/a-ce/bispectral-index.html - bispectral index (measurement of the depth of unconsciousness)
  
• http://www.surgeryencyclopedia.com/ce-fi/esophagogastroduodenoscopy.html - esophagogastroduodenoscopy
  
• http://www.surgeryencyclopedia.com/fi-la/gastrectomy.html - gastrectomy