Steve Saltzman, MD1, Dominique Howard, MD2, Justin Kweit, BSc2, M. Aamir Ali, MD2 1Capital Anesthesia Partners, Chevy Chase, MD; 2Capital Digestive Care, Chevy Chase, MD Introduction: Gastrointestinal endoscopy (GIE) procedures, which include esophagogastroduodenoscopy (EGD) and colonoscopy, account for the most procedures performed in ambulatory surgery centers (ASC). Though clinical guidelines do not support routine administration of intravenous fluids (IVF) , many ASC's routinely administer intraprocedural IVF to all patients. The national shortage of saline caused by Hurricane Helene in September 2024 provided an opportunity for our large, community based ASC's that routinely administer IVF for GIE to evaluate the safety of a protocol of restricting intraprocedural IVF only to higher risk patients. Methods: Historically, all ASC patients undergoing GIE would receive IVF at the practice. In response to the national saline shortage, we adopted a restrictive IVF protocol in September 2024. Under this protocol, IVF were limited to patients aged 70 or older, diabetics or those undergoing double procedures (DP) (EGD and colonoscopy), and those who were dehydrated in the assessment of the anesthetist. Rescue IVF were given at the anesthetist's discretion, including for clinical signs of hypotension, which was defined as sustained decrease in systolic blood pressure to < 90 mm Hg, or transient decrease on two separate occasions. Demographic data was recorded and all adverse events were tracked for patients in the restrictive IVF protocol until discharge, including need to administer IVF within or after the procedure , Results: Over 5 months, 4853 GIE were completed, including 3713 colonoscopies, 580 RGD's, 557 DP's and 3 sigmoidoscopies. Of these 2792 (58%) met criteria for the restrictive IVF protocol. 103 patients (3.7%) had hypotension during or after the procedure, and 35 !1.25%) were given IVF. Of the IVF restricted patients receiving IVF, hypotension was the reason in 19 (54%), arrhythmia in 1 (3%), and "other causes" in the remainder. Of the IVF restricted patients, fluids were given in response to concerns raised in the post-anesthesia care unit (PACU) in 19 (54%) patients. 16 (84%)of the patients received IVF in the PACU for hypotension. Discussion: A protocol restricting IVF to older patients, diabetics and those having DP had a low risk of adverse events. While 3.7% of patients had hypotension, this was significant enough to require rescue IVF in only 1.25%. There were no serious complications. A protocol of restrictive IVF in patients undergoing GIE at ASC's appears to be safe. Our findings are in line with existing data and clinical practice recommendations.
Figure: Table 1: Summary of findings
Disclosures: Steve Saltzman indicated no relevant financial relationships. Dominique Howard indicated no relevant financial relationships. Justin Kweit indicated no relevant financial relationships. M. Aamir Ali: Trillium Bio – Owner/Ownership Interest.
Steve Saltzman, MD1, Dominique Howard, MD2, Justin Kweit, BSc2, M. Aamir Ali, MD2. P0858 - Restricting Routine Use of Intravenous Fluid Before Outpatient Endoscopy Does Not Increase Adverse Outcomes, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
