TY - JOUR
T1 - Significantly reduced hypoxemic events in morbidly obese patients undergoing gastrointestinal endoscopy
T2 - Predictors and practice effect
AU - Goudra, Basavana Gouda
AU - Singh, Preet Mohinder
AU - Penugonda, Lakshmi C.
AU - Speck, Rebecca M.
AU - Sinha, Ashish C.
PY - 2014/1
Y1 - 2014/1
N2 - Background: Providing anesthesia for gastrointestinal (GI) endoscopy procedures in morbidly obese patients is a challenge for a variety of reasons. The negative impact of obesity on the respiratory system combined with a need to share the upper airway and necessity to preserve the spontaneous ventilation, together add to difficulties. Materials and Methods: This retrospective cohort study included patients with a body mass index (BMI) >40 kg/m 2 that underwent out-patient GI endoscopy between September 2010 and February 2011. Patient data was analyzed for procedure, airway management technique as well as hypoxemic and cardiovascular events. Results: A total of 119 patients met the inclusion criteria. Our innovative airway management technique resulted in a lower rate of intraoperative hypoxemic events compared with any published data available. Frequency of desaturation episodes showed statistically significant relation to previous history of obstructive sleep apnea (OSA). These desaturation episodes were found to be statistically independent of increasing BMI of patients. Conclusion: Pre-operative history of OSA irrespective of associated BMI values can be potentially used as a predictor of intra-procedural desaturation. With suitable modification of anesthesia technique, it is possible to reduce the incidence of adverse respiratory events in morbidly obese patients undergoing GI endoscopy procedures, thereby avoiding the need for endotracheal intubation.
AB - Background: Providing anesthesia for gastrointestinal (GI) endoscopy procedures in morbidly obese patients is a challenge for a variety of reasons. The negative impact of obesity on the respiratory system combined with a need to share the upper airway and necessity to preserve the spontaneous ventilation, together add to difficulties. Materials and Methods: This retrospective cohort study included patients with a body mass index (BMI) >40 kg/m 2 that underwent out-patient GI endoscopy between September 2010 and February 2011. Patient data was analyzed for procedure, airway management technique as well as hypoxemic and cardiovascular events. Results: A total of 119 patients met the inclusion criteria. Our innovative airway management technique resulted in a lower rate of intraoperative hypoxemic events compared with any published data available. Frequency of desaturation episodes showed statistically significant relation to previous history of obstructive sleep apnea (OSA). These desaturation episodes were found to be statistically independent of increasing BMI of patients. Conclusion: Pre-operative history of OSA irrespective of associated BMI values can be potentially used as a predictor of intra-procedural desaturation. With suitable modification of anesthesia technique, it is possible to reduce the incidence of adverse respiratory events in morbidly obese patients undergoing GI endoscopy procedures, thereby avoiding the need for endotracheal intubation.
KW - Airway
KW - colonoscopy
KW - endoscopic retrograde cholangiopancreatography
KW - endoscopy
KW - morbid obesity
UR - http://www.scopus.com/inward/record.url?scp=84893500345&partnerID=8YFLogxK
U2 - 10.4103/0970-9185.125707
DO - 10.4103/0970-9185.125707
M3 - Article
C2 - 24574597
AN - SCOPUS:84893500345
SN - 0970-9185
VL - 30
SP - 71
EP - 77
JO - Journal of Anaesthesiology Clinical Pharmacology
JF - Journal of Anaesthesiology Clinical Pharmacology
IS - 1
ER -