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Significantly reduced hypoxemic events in morbidly obese patients undergoing gastrointestinal endoscopy: Predictors and practice effect.

Goudra BG, Singh PM, Penugonda LC, Speck RM, Sinha AC - J Anaesthesiol Clin Pharmacol (2014)

Bottom Line: Our innovative airway management technique resulted in a lower rate of intraoperative hypoxemic events compared with any published data available.These desaturation episodes were found to be statistically independent of increasing BMI of patients.Pre-operative history of OSA irrespective of associated BMI values can be potentially used as a predictor of intra-procedural desaturation.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Gastrointestinal endoscopy case load
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Figure 2: Gastrointestinal endoscopy case load

Mentions: “Out of operating room” anesthesia is one of the fastest growing areas of clinical practice. At the Hospital of the University of Pennsylvania, we have had an almost 300% increase [Figure 1] over the last 3 years, much of this attributable to gastrointestinal (GI) endoscopy [Figure 2]. Upper GI endoscopy, in particular, is challenging for the anesthesia provider. The shared airway, increased risk of aspiration, preference for spontaneous ventilation and relative non-availability of rapid help during an emergency due to the remote location, all increase anesthesia risks. The mortality and morbidity is relatively high and is mainly related to airway management.[1] It is to be expected that, morbidly obese patients as a group (individuals with a body mass index [BMI] greater than 40 kg/m2), are likely to have an even higher rate of perioperative complications. Although the American Society of Anesthesia (ASA) recommends that emergency help should be available at all times,[2] it does not specify the quality and nature of emergency support. Again, in the opinion of ASA’ task force on perioperative management of patients with obstructive sleep apnea (OSA), general anesthesia with a secured airway is preferable to moderate or deep sedation for most patients with OSA. A significant number of morbidly obese patients presenting for GI endoscopy have OSA. In spite of this, our approach is one of providing intravenous general anesthesia without endotracheal intubation.


Significantly reduced hypoxemic events in morbidly obese patients undergoing gastrointestinal endoscopy: Predictors and practice effect.

Goudra BG, Singh PM, Penugonda LC, Speck RM, Sinha AC - J Anaesthesiol Clin Pharmacol (2014)

Gastrointestinal endoscopy case load
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927297&req=5

Figure 2: Gastrointestinal endoscopy case load
Mentions: “Out of operating room” anesthesia is one of the fastest growing areas of clinical practice. At the Hospital of the University of Pennsylvania, we have had an almost 300% increase [Figure 1] over the last 3 years, much of this attributable to gastrointestinal (GI) endoscopy [Figure 2]. Upper GI endoscopy, in particular, is challenging for the anesthesia provider. The shared airway, increased risk of aspiration, preference for spontaneous ventilation and relative non-availability of rapid help during an emergency due to the remote location, all increase anesthesia risks. The mortality and morbidity is relatively high and is mainly related to airway management.[1] It is to be expected that, morbidly obese patients as a group (individuals with a body mass index [BMI] greater than 40 kg/m2), are likely to have an even higher rate of perioperative complications. Although the American Society of Anesthesia (ASA) recommends that emergency help should be available at all times,[2] it does not specify the quality and nature of emergency support. Again, in the opinion of ASA’ task force on perioperative management of patients with obstructive sleep apnea (OSA), general anesthesia with a secured airway is preferable to moderate or deep sedation for most patients with OSA. A significant number of morbidly obese patients presenting for GI endoscopy have OSA. In spite of this, our approach is one of providing intravenous general anesthesia without endotracheal intubation.

Bottom Line: Our innovative airway management technique resulted in a lower rate of intraoperative hypoxemic events compared with any published data available.These desaturation episodes were found to be statistically independent of increasing BMI of patients.Pre-operative history of OSA irrespective of associated BMI values can be potentially used as a predictor of intra-procedural desaturation.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus