Gastric Varices (21 of 25)

To avoid bronco aspiration the patient must be with endotracheal tube. This image as well as the video clips show endotraqueal tube, there are a plenty of fresh blood in the oropharynx, that is the main reason to perform this procedure in the operation room. We can see the endotracheal tube that is placed to prevent aspiration. Every patient who has hematemesis should have an upper endoscopy practiced under general anesthesia, with placement of an endotracheal tube. In this example we can clearly see the amount of blood in the oropharynx. Orotracheal intubation is indicated when there is risk of aspiration because of continuous hematemesis. The main complications associated with gastrointestinal bleeding in patients with hepatic cirrhosis include aspiration, hepatic encephalopathy, and renal failure. All of the complications mentioned cause rapid deterioration of the patient and are an important cause of death. The major risk for aspiration occurs during hematemesis and upper endoscopy, as well as during esophageal tamponade, especially in patients with altered consciousness. Prevention of aspiration is obtained by orotracheal placement in patients with grade III-IV encephalopathy, as well as aspiration of gastric contents before the endoscopic procedure by means of a nasogastric tube.