Elective Paediatric Gastroscopy +/- Colonoscopy

Fasting

• Solids and non-human milk 6h
• Formula 4h
• Breast milk 3h
• Clear fluids up to 1h

Postpone / optimise first (elective)

• Active URTI: fever, productive cough, purulent nasal discharge, chest signs; usually rebook ~2 weeks

Topical Local Anaesthetic

• Ametoptopical, 30-45 mins prior
• EMLAtopical, 1 hour prior

• Paedfusor: age 1-16 years
• Single Syringe Technique (use with caution): Propofol1% + Remifentanil2.5 - 5mcg/ml
• Bite guard, nasal O2 with capnography sampling

• Parental support
• Pre-oxygenate

If IV access:

• PropofolTCI, Paedfusor Cpt 3-5 + RemifentanilTCI / Single-Syringe Technique (SST)
• Wait for adequate depth of anaesthesia before airway manipulation

If IV access not appropriate:

• sevofluraneHigh flow + Nitrous Oxide
• IV access once asleep, then switch to PropofolTCI + RemifentanilTCI / SST maintenance

• No airway device, spontaneous ventilation
• Bite guard, nasal O2 + capnography

• PositionLeft lateral
• Scope insertion most stimulating (cough, breath holding, laryngospasm)
• Insufflation can splint the diaphragm in small children (suction if desaturating)

Maintenance

• PropofolTCI, Paedfusor Cpt 3-4
• RemifentanilTCI / SST
• Spontaneous ventilation preserved at these rates; watch capnography + clinical signs for apnoea

Analgesia

• Paracetamol15mg/kg, IV : 10mg/kg if 10kg or less

Anti-emetics

• Ondansetron0.15mg/kg
• Dexamethasone0.15mg/kg

• Stop infusion as scope withdrawn; suction air from stomach
• Recover in lateral position

• Paracetamol15mg/kg
• Ondansetron0.15mg/kg, PRN
• Sore throat common; eat and drink when awake
• Day case discharge per unit criteria

1. Left lateral, bite guard in
2. Scope through pharynx and upper oesophageal sphincter (most stimulating)
3. Oesophagus, stomach, duodenum with air / CO2 insufflation
4. Biopsies (painless)
5. Withdrawal, air suctioned -> stop TIVA