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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

CO2 out port of an elbow adapter used to deliver supraglottic jet ventilation via nasal trumpet during an endoscopic retrograde cholangiopancreatography
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Figure 4: CO2 out port of an elbow adapter used to deliver supraglottic jet ventilation via nasal trumpet during an endoscopic retrograde cholangiopancreatography

Mentions: Use of supraglottic jet ventilation using a hand held jet device to treat apnea or hypopnea (although in this series, only one patient was supplemented with supraglottic jet ventilation). The actual device and the connections are represented in the picture [Figure 4]. The entrained air from the reservoir bag of the attached breathing system (connected to the nasal trumpet) contains a high percentage of oxygen


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)

CO2 out port of an elbow adapter used to deliver supraglottic jet ventilation via nasal trumpet during an endoscopic retrograde cholangiopancreatography
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: CO2 out port of an elbow adapter used to deliver supraglottic jet ventilation via nasal trumpet during an endoscopic retrograde cholangiopancreatography
Mentions: Use of supraglottic jet ventilation using a hand held jet device to treat apnea or hypopnea (although in this series, only one patient was supplemented with supraglottic jet ventilation). The actual device and the connections are represented in the picture [Figure 4]. The entrained air from the reservoir bag of the attached breathing system (connected to the nasal trumpet) contains a high percentage of oxygen

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