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Clinical Assessment

Introduction

Anesthesia consultation is essential prior to any intervention. Ideally it should take place 48 hours before the scheduled procedure, although due to the large number of emergency cases this is not always possible.

Absolute contraindications to diagnostic or therapeutic endoscopy are rare, although it is always preferable to identify patients at risk in order to be adequately prepared at the time of the procedure in order to avoid complications.

Clinical Assessment

A thorough pre-procedure clinical assessment will identify high risk patients.

Patients at high risk are included in the following list : severe obstruction of the central airways, particularly at the level of the trachea, patients status post pneumonectomy or myocardial infarct, unstable patients with cardiovascular or respiratory insufficiency, patients with large pulmonary abscesses or massive pulmonary hemorrhage, coagulopaths or patients on therapeutic anti-coagulation regimens, and those with severe liver dysfunction. We could add to the list a few more, including ; irradiated lung cancer patients, those with superior vena cava syndrome, aortic aneurysms, immunosuppressed patients, severe asthmatics, patients with cystic fibrosis, renal insufficiency, or pulmonary hypertension, and finally uncooperative patients.

Pre-procedure testing

Pre-procedure testing should include a basic metabolic panel along with coagulation studies. Arterial blood gas analysis is optional, but should be ordered if the patient’s respiratory status is compromised.

 
 
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