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

Basavana Gouda Goudra, Preet Mohinder Singh, Lakshmi C Penugonda, Rebecca M Speck, Ashish C Sinha, Basavana Gouda Goudra, Preet Mohinder Singh, Lakshmi C Penugonda, Rebecca M Speck, Ashish C Sinha

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.

Keywords: Airway; colonoscopy; endoscopic retrograde cholangiopancreatography; endoscopy; morbid obesity.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Total out of operating room anesthesia case load. EP: Electrophysiological procedures, GI: Gastrointestinal endoscopy, and RAD: Radiological procedures
Figure 2
Figure 2
Gastrointestinal endoscopy case load
Figure 3
Figure 3
A size 32 nasal trumpet connected to mapleson-C breathing system
Figure 4
Figure 4
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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Source: PubMed

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