Anaesthetic strategies and risk mitigation in GI endoscopic procedures

Abstract

Gastrointestinal (GI) endoscopic procedures often require sedation and analgesia to improve patient comfort and procedural success, yet they pose significant anesthetic risks, including hypoxemia, pulmonary aspiration, apnea, bradycardia, and cardiac arrest.This article examines the critical role of preoperative evaluation, risk stratification, and tailored intraoperative anesthesia strategies in minimizing complications such as bleeding, visceral perforation, and venous air embolism. Key procedures requiring sedation, such as Endoscopic Retrograde Cholangiopancreatography (ERCP), Endoscopic Submucosal Dissection (ESD), and Peroral Endoscopic Myotomy (POEM), are detailed alongside tools like the Airway Protection Score (APS), Revised Cardiac Risk Index (RCRI), and Glasgow-Blatchford Bleeding Score (GBS) for risk assessment. The article addresses challenges in morbidly obese patients, including altered pharmacokinetics and respiratory risks, and emphasizes perioperative monitoring with point-of-care testing (POCT) and capnography. Management of intraprocedural complications, including airway management and aspiration prevention, is discussed, with evidence supporting high-flow nasal oxygen (HFNO) and endotracheal intubation. The multidisciplinary approach involving anesthesiologists, gastroenterologists, and nurses is highlighted to optimize outcomes.