“… listed for cystogastrostomy due to parapacreatic cyst under general anaesthetic/anaesthetic led sedation. Previous attempt under gastroenterologist sedation abandoned due to tachypnoea. Patient and family (mother and partner) informed prior to procedure about planed conduct of anaesthesia. Plan A anaesthetic led sedation and if not tolerating or complicated procedure plan B general anaesthetic. Patient supine and sedated with propofol infusion and fentanyl. Oxygenation maintained with high flow nasal oxygen with
end tidal CO2 monitoring and BIS. Endoscope inserted by gastroenterologist and hot axios (cystogastrostomy) performed. At that time cystic fluid started draining into the stomach, suctioned by gastro team via endoscope. Once rate of fluid drainage had reduced and suctioned, endoscope removed in order to facilitate placement of further drain. At that point cystic fluid noted to be continuously coming out of pharynx. High suspicion of aspiration into lungs.”

Standards of monitoring during sedation are covered in the Association’s recent guideline [1] and in this case, it appears that they were adhered to. There is a finite risk of regurgitation and aspiration with this type of procedure, and it is important that the joint plan includes means of detecting this and dealing with it. There should also be a reasoned decision about what level of airway protection is indicated. Supraglottic airway devices are available for use during this type of procedure.[2,3] Depending on the assessed level of risk, tracheal intubation may be indicated.

1. Standards of Monitoring During Anaesthesia and Recovery, Association of Anaesthetists, 2021.
2. LMA Gastro Airway Datasheet, Teleflex Incorporated, 2018.
3. VBM Gastro-laryngeal Tube G-LT Datasheet, VBM Medizintechnic GmbH.