A. What is painless gastroscopy?
Painless gastroscopy is the appropriate application of sedative anesthetics during gastroscopy treatment, so that the patient can complete the examination and/or treatment under awake sedation or light sleep, and the whole process is comfortable, painless and memory-free for the patient. This technique can effectively improve the pain tolerance and physical and mental relaxation of the examinees, but not like the deep anesthesia state during surgery. Under the supervision of anesthesiologists or nurses, gastroenterologists operate the microscopy in the same way as general gastroscopy.
Commonly used anesthetic drugs
Widely used at home and abroad commonly used anesthetic drugs for isoproterenol, the drug has a fast onset, rapid disappearance of the effect, controllability, no accumulation in the body, the characteristics of small toxicity. The general dosage of 1 to 2mg/kg body weight, the patient will lose consciousness within 1 minute, and the depth and time of anesthesia will be controlled by the anesthesiologist according to the needs of endoscopic operation at any time, and the patient will wake up in about 5 minutes after the endoscopy.
At present, the commonly used drugs are (1) isoproterenol; (2) imipramine; (3) isoproterenol + fentanyl; (4) isoproterenol + imipramine; (5) isoproterenol + fentanyl + imipramine; (6) isoproterenol + small dose ketamine; (7) isoproterenol + tramadol; (8) isoproterenol + etomidate (9) isoproterenol + remifentanil.
III. Applicable population
1. Those who voluntarily request painless gastroscopy;
2. Those who have indications for gastroscopy but are afraid of routine gastroscopy;
3. those who have difficulty in completing routine gastroscopy due to violent vomiting or other reasons;
4. those who have other diseases and have a strong need for gastroscopy. Such as hypertension, mild coronary heart disease, angina pectoris, old myocardial infarction, history of epilepsy and pediatric or psychiatric patients who cannot cooperate.
IV. Contraindicated groups
In principle, the contraindications are the same as those for conventional gastroscopy (see health guidance for gastroscopy). 2;
2. those with a history of drug allergy, especially allergy to narcotic sedative drugs. 3;
3. pregnant and lactating women;
4. diseases that tend to cause asphyxia, such as sputum, full stomach, respiratory obstruction, acute respiratory tract infection, etc;
5. Shock;
6. hepatic encephalopathy (including subclinical hepatic encephalopathy);
7. Severe heart, liver and kidney diseases;
8. Severe snoring and excessive obesity are recommended;
9. caution for bradycardia.
V. Painless and senseless examination process and time
Before the examination, electrocardiogram and chest X-ray should be done, and the anesthesiologist should assess the physical condition of the patient and ask if there is any medical history of drug allergy. Interpret the results of physical examination and ancillary tests, screen the patient and make a conclusive opinion. 2.
2. develop a specific sedation and anesthesia plan. 3.
3. inform the patient of the condition and sign the informed consent form for painless gastrointestinal examination under sedation and anesthesia with the family or patient. 4.
4. Pre-operative preparation For gastroscopy without gastric retention, abstain from drinking for 4-6 hours, and preferably from eating for more than 8 hours; for colonoscopy, take oral medication to cleanse the intestinal tract 4 hours before the procedure until watery stool is passed.
5. Assist the patient to assume a good position, remove the movable denture, and administer oxygen, monitor blood pressure, pulse rate, oxygen saturation, heart rate and ECG.
6. Administer intravenous analgesic and sedative agents to block the sensation of pain; observe the patient to reach a hazy anesthesia state and start the examination.
7. The whole examination takes about 5-10 minutes. 8.
8. After the examination, you can rest for about 60 minutes and move around normally. Generally speaking, dizziness lasting 20-30 minutes is normal and is not a cause for concern.
9. The following criteria are met before leaving the hospital: (1) blood pressure returns to preoperative level or close to it; (2) awake as usual and able to respond correctly; (3) stable gait.
VI. Precautions
1. Gastroscopy should be performed on an empty stomach, fasting after ten o’clock in the evening before the examination, and no water or drinks should be consumed four hours before the examination.
2. please wear loose, convenient and easy to loosen clothing and pants, please do not bring valuables; patients wearing movable dentures, remove the dentures.
3. Please do not wear jewelry, watches, and ladies please do not wear lipstick or nail polish.
4. Please do not drink, drive, operate machinery or sign legal documents within 24 hours after the examination.
5. Please inform the medical staff in advance if you have any abnormal heart and lung function or have been allergic to anesthetic drugs.
6. A family member or friend must accompany you on the day of the examination. Patients with special conditions may need to stay in the hospital for observation.
7. Please contact the anesthesiologist and sign the anesthesia consent form before the examination.
8. You should not drink or eat until two hours after the examination, but warm, cold, thin rice, noodles and other soft foods should be served within 24 hours. Spicy food is prohibited on the same day, and you should not eat too much.
9. Some people feel sore throat, foreign body sensation or a little bleeding after the examination, mostly due to the gastrointestinal mirror rubbing the mucous membrane of the throat during the examination, which will disappear automatically after a period of time. If the symptoms are serious, taking throat tablets and gargling with anti-inflammatory solution, or taking Yunnan Baiyao orally for bleeding can make the symptoms disappear and reduce the discomfort.
Advantages of painless gastroenteroscopy
1. It allows the patient’s whole body to relax, so that he or she will not be nervous before the examination, and the examination will be safe and without discomfort, and the result will be more accurate as he or she will recover soon after the examination.
2. It allows the doctor to carefully examine all parts of the stomach and make a more accurate diagnosis, and at the same time, it can avoid the damage to the digestive tract caused by the instruments when entering the mirror, which is beneficial to the judgment and treatment of the disease.
3. shorten the examination time of gastroscopy, which greatly improves the effect of examination. Painless gastroscopy has been listed as the preferred method for patients who are uncooperative or poorly tolerated due to mental stress and who must undergo gastroscopic treatment, especially for the elderly and children.
It helps to reduce complications caused by stress, fear and non-cooperation, such as cardiovascular accidents, intestinal spasm, bleeding, perforation, etc.
VIII. Disadvantages of painless gastroenteroscopy
1. People with asthma, hypertension, diabetes mellitus and poor cardiopulmonary function, which account for about one-fifth of all examinations, are not suitable for painless endoscopy.
2. It depends on anesthesiologists and clinicians to support the whole scene.
3. need to be accompanied within 3h after the operation.