Pediatric Gastroenterology (Presby Tower)

Pediatric Gastroenterology (Presby Tower)

Authors: Joseph Sisk MD, Tracye Carter, CRNA

Surgeons: Altaf, Grunow, Marshall, Palle, Shaukat, Steele, Talathi, Tung

ORs: Procedure Room #3

Last Update: 5.21.21


The Peds GI Pre-op and PACU is located in the back of the PNCU on the 1st floor of Presby Tower.

If you come off the skywalk, take a sharp right and you'll see the waiting room.

Continue through PNCU to the back and you will see bays 13-18.

This is GI Pre-OP and PACU.

The GI Suite is Procedure Room #3.

Procedure Room


  • is a physician's workroom and a break room across from the GI suite.

      • The code for the doors is 9876#


  • There is a restroom across from the GI suite.


  • Check-In

      • Pre-OP, patients will be brought back to a bay and checked in by a Peds Nurse. They will obtain an HCG at this time, if indicated.

  • COVID tests

      • If done at OSH, are in the patient folder at the nursing desk in pre-op.

  • Premedication

      • Pre-op oral versed is available if ordered. The pre-op nursing is able to administer this.

  • IV Access

      • Nurses may place pre-op PIVs, but I found myself offering nitrous oxide to those that needed awake IVs.

  • Glucometer

      • PNCU has a glucometer that may be used if needed

  • Centricity EMR

      • Centricity Pre-Ops will be skeletonized by our PAs but require completion by the attending.

      • At present, the only computer with Centricity on it is in the PNCU or Procedure room. They are working to get it installed in the Pre-Op/PACU area.

      • Centricity currently defaults to PNPTCLP006 which is in the back of PNCU.

            • This should be updated to print on the printer in pre-op/PACU (PNPTCLP005) soon.


  • Gas Supply

      • There is a pipeline O2 supply.

      • Both Nitrous Oxide and Air supply comes from tanks on the back of the machine.

            • These must be turned on and off each day.

  • Monitor and Ventilator Defaults

      • Most of the monitors and anesthesia machines currently default to adult settings.

            • This means the secondary gas is air and the default vent setting is a TV of 500ml.


  • The procedure room setup has the same supplies as the GI Suite at OCH.

  • Locating the case in Centricity

      • For vitals to transmit, assign the case to:

            • Unit: EOR

            • Room E.ORGI3


  • Extubation:

      • Awake v Deep

            • Deep extubations can be done if indicated.

            • It is recommended that the attending anesthesiologist remain with the patient in PACU while the CRNA turns over over the room.

            • Do not roll back to the procedure room with the next patient until the previous emerges from Anesthesia and no longer has their oral airway in place.

            • Consider having both providers carry an emergency drug bag on them.

  • The patients are recovered by Peds nurses who are familiar with deep extubations

  • The Pre-Op and PACU bays are tight spaces.

      • Consider ordering IV fluids to be TKO or saline locked so the nurses do not need to use a pump.

  • Consider ordering acetaminophen for PACU as these patients will not receive Tylenol premedication.


  • Anesthesia Techs:

      • Our pediatric anesthesia techs have done a super job ensuring we have adequate supplies

      • It is helpful to have the circulator call the Presby anesthesia techs when they call report to PACU.

          • The adult techs did their best to arrive in a timely fashion but most of the turnover will fall on the CRNA.

          • The time it takes the attending to recover the child in PACU provides the extra time to get this done.

          • Because the adult techs are not made privy to the patient information on the tracker, they are unfamiliar with the age of the patient, the appropriate sized equipment.

          • Consider having the techs work to sanitize the anesthesia station and empty the trash while you perform a patient-appropriate set-up yourself.

          • For the older patients that require an adult circuit, the techs have pre-made packs filled with:

1. A Circuit

2. Suction

3. Blue towels

4. Maks

5. Tongue depressor

6. Oxygen facemasks for transport

7. BP cuff, pulse ox, electrodes

8. Trash bag

9. Some miscellaneous items

· These packets are located outside the GI suite and have proved to be quite helpful. You will still have to set out your own airway equipment and pediatric monitors.

  • Please deposit used blades in the designated biohazard labeled bin.

o The GI nurses will return them to the peds side for sterile processing.


  • The procedure room Pyxis has our standard peds medications including precedex

  • There is a central pyxis in PNCU which contains dilute epinephrine

Equipment availability:

  • Code Cart

      • The Peds-to-Adult Code cart is in Pre-Op/PACU

  • PACU Airway Cart

      • There is a pediatric basic airway cart in Pre-Op/PACU

            • This contains Mapleson Circuits, OPAs, LMAs, etc.

  • Mapleson Circuits

      • These are located in the Pre-Op/PACU Airway Cart

      • Individual PACU bays also have Mapleson circuits at bedside

  • Malignant Hyperthermia Cart

      • The MH Cart is in PNCU

  • Video Laryngoscope/Ultrasound

      • Presby Anesthesia techs can quickly bring us an ultrasound or video laryngoscope if requested

      • There is a Glidescope on this floor which is shared with Cath Lab

  • Communication

      • Cell service in the Peds GI area appears adequate

  • Replacement Nitrous Oxide/Air cylinders

      • The Techs told can quickly provide new Nitrous Oxide and Air cylinders if called.

Emergency Assistance:

  • There are adult Anesthesia providers working in the Adult GI section of the PNCU

  • Important Phone Numbers

        • OUMC Airway Phone

            • (405) 417-0094

        • Presby Boardrunner

            • (405) 271-0721

        • Presby 24hr Anesth tech hotline

            • (405) 248-7160

        • Anesthesia Tech on Duty

            • (405) 209-7701


  • Overall, the workflow is similar to MRI

  • The Anesthesia Attending should review the charts prior to the start of the day.

      • Update all COVID tests.

  • Nursing will room the patients and check them in.

  • Assess for pre-medication need early.

      • Tell nurse if it is ordered.

  • Identify IV plan ASAP.

  • Induce as you would in GI

  • Consider seeing the next patient as the case proceeds.

      • If not, it can be done after the case.

  • Extubate as you would in GI.

      • If deep, the attending should stay with the patient until the Oral Airway is out while the CRNA turns over the room.

  • Roll back with the next patient only after Oral Airway is out.

Work in Progress:

  • Centricity needs to be installed on computers in Pre-Op/PACU. Ideally on the nursing computer and a COW.

  • Procedure Room #3 needs a narcotics waste receptacle

  • The Anesthesia Machine Vent and Monitors need to be configured to Pediatric Settings as default

  • Pre-OP/PACU vitals monitors should be configured to Pediatric Settings as default