GA and ERCPs - to Karyn

[Guest guest]

While I was doing the search for GA, I ran into an article that

described doing an ERCP prior to the cholecystectomy while the

patient was under GA in the OR. This was not inter-operative

cholangiography that most surgeons describe, but the actual

ERCP.

The article stated that they were studying this approach as

opposed to doing the ERCP days ahead of the lap-choly to limit

the patient to GA exposure.

Now I am not sure if the GA they were describing was the near

paralysis or the full intubation, so I am not sure if the scope set

up was fitted for the trach tube or if they intubated as soon as the

ERCP was done and put the patients under even deeper.

However, I would think that there would have to be some kind of

modification out there where you can use an endoscope along

with the tube - after all you are going down two different " tubes "

(tracheal versus esophageal).....and it is standard to have a

suction tool at the same time as intubation (in emergency work,

we oftentimes suctioned at the same time to prevent aspiration).

In fact to a certain extent, I would think intubation would be a

protection against aspiration induce pneumonia during ERCP by

supplying a physical barrier between tracheal and esophageal

route. But here I am just speculating and may be showing my

ignorance.

Your experience with the sedation and IV access is one that I

have encountered quite frequently. Since my descent into the first

circle of pancreas hell (or is it the ninth?) I have had no luck with

IV sticks. The so-called expert (anesthesiologist) stuck me over

20 times in my arms and hands and feet before he decide to go

to the jugular (EJ). Then he had to stick me three times there

before he got one going. It took him over two hours of constant

poking. As soon as he got access he knocked me out...within

seconds. I think he wanted me to forget what happened but it is

all very clear to me, even the look of horror on the nurses face

when he became like a man obsessed. The one good thing that

I have to say about indiana was that they CT crew used an

ultrasound to find my vein and the tech was very good - about the

best that I have had since I " lost " my veins! I highly recommend it

and will not allow anyone to go blind anymore.

laurie