title: Airway Management During Upper GI Endoscopic Procedures: State of the Art Review.
abstract: With the growing popularity of propofol mediated deep sedation for upper gastrointestinal (GI) endoscopic procedures, challenges are being felt and appreciated. Research suggests that management of the airway is anything but routine in this setting. Although many studies and meta-analyses have demonstrated the safety of propofol sedation administered by registered nurses under the supervision of gastroenterologists (likely related to the lighter degrees of sedation than those provided by anesthesia providers and is under medicolegal controversy in the United States), there is no agreement on the optimum airway management for procedures such as endoscopic retrograde cholangiopancreatography. Failure to rescue an airway at an appropriate time has led to disastrous consequences. Inability to evaluate and appreciate the risk factors for aspiration can ruin the day for both the patient and the health care providers. This review apprises the reader of various aspects of airway management relevant to the practice of sedation during upper GI endoscopy. New devices and modification of existing devices are discussed in detail. Recognizing the fact that appropriate monitoring is important for timely recognition and management of potential airway disasters, these issues are explored thoroughly.
authors.affiliation: Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. goudrab@uphs.upenn.edu.
authors.forename: Basavana
authors.initials: B
authors.lastname: Goudra
authors.affiliation: Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, 110029, India.
authors.forename: Preet Mohinder
authors.initials: PM
authors.lastname: Singh
mesh_terms: D058109:Airway Management / Q000295:instrumentation / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D019296:Capnography; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D054810:Deep Sedation / Q000379:methods*; D017097:Electric Impedance; D016145:Endoscopy, Digestive System / Q000379:methods; D006801:Humans; D007440:Intubation; D008397:Masks; D016343:Monitoring, Intraoperative; D056888:Patient Positioning; D015742:Propofol / Q000627:therapeutic use; D053120:Respiratory Aspiration / Q000517:prevention & control*
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol
keywords: Advanced endoscopy; Airway devices endoscopy; Anesthesia; Anesthesia tips endoscopy; ERCP