Age, anemia, and obesity-associated oxygen desaturation during upper gastrointestinal endoscopy

Dhariwal, A. P. S.; Plevris, John; Lo, Nanidzhanian; Finlayson, N.; Heading, R C; Hayes, PC

doi:10.1016/s0016-5107(92)70564-1

Cited by 72 publications

(47 citation statements)

References 14 publications

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“…Factors predicting desaturation with endoscopic procedures include a baseline oxygen saturation below 95%, an American Society of Anesthesiologist score of 3 or 4, sedation [33], respiratory disease with increasing desaturation seen with decreasing FEV 1 [34,35], old age, and anemia [36]. While we found no reports relating obesity to outcomes of bronchoscopy, a BMI >28 has been shown to be an independent risk factor for desaturation during gastrointestinal endoscopy [37]. Iwao et al [38] in 1994 did not find BMI or total endoscopy time to be associated with oxygen desaturation, though it has to be considered that the patients in their study were not sedated.…”

Section: Discussionmentioning

confidence: 99%

Sedation for Bronchoscopy and Complications in Obese Patients

Khan¹,

Chatterjee

Bellinger

et al. 2016

Respiration

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Background: Bronchoscopy is a safe and minimally invasive diagnostic tool, but no studies have reported prospectively on sedation and outcomes in patients with objectively defined obesity. Objectives: The purpose of the study is to determine if obese patients require more sedation or had more procedural complications during bronchoscopy under moderate sedation than non-obese patients. Methods: We evaluated complications and sedation requirements in non-obese versus obese patients, defined by multiple criteria including body mass index (BMI), neck circumference, abdominal height, and Mallampati scores. Results: Data were collected prospectively in 258 patients undergoing bronchoscopy under moderate sedation. By varying criteria, there were the following proportions of obese patients: 30% by BMI >30, 39% by neck circumference >40 cm, and 35% by abdominal height >22 cm in males and >20 cm in females. Sedative and analgesic dosing was not clinically significantly higher in obese patients than in non-obese patients. There was no difference in complications or procedural success based on obesity criteria. Hemoglobin oxygen desaturations occurred more often during bronchoscopy in patients with increasing Mallampati scores (p = 0.04), but this had no effect on bronchoscopy time or successful completion of the procedure. A subset of patients with previous polysomnogram-proven obstructive sleep apnea were more likely to have earlier termination of their procedure (15.8%) than patients with no diagnosed sleep apnea (2.3%; p = 0.002). Conclusion: In this prospective assessment of patients with obesity, we found neither clinically significant differences in sedation needs nor increases in complications in obese versus non-obese patients using a variety of indices of obesity.

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Section: Discussionmentioning

confidence: 99%

Sedation for Bronchoscopy and Complications in Obese Patients

Khan¹,

Chatterjee

Bellinger

et al. 2016

Respiration

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“…27 Nonrisk factors included the dose of midazolam, ASA classification ( I or II ), and use of propofol.TheASA classification was developed as a means of determining anesthetic risk. Interestingly, these results show that ASA classification (I or II ), when used to determine the risk of experiencing low-saturation events during dental sedation, was not predictive.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Oxygen Saturations Recorded During Dental Intravenous Sedations: A Retrospective Quality Assurance of 3500 Cases

Viljoen¹,

Coombs

Mahoney

et al. 2011

Anesthesia Progress

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The death of a patient under sedation in New South Wales, Australia, in 2002 has again raised the question of the safety of dental sedation. This study sought answers to 2 questions: Can safe oxygen saturation levels ($94%) be consistently maintained by a single operator/sedationist ? Does the additional use of propofol, in subanesthetic doses, increase the risk of exposure to hypoxemia ? Three thousand five hundred cases generated between 1996 and 2006 were randomly examined and divided into 2 subcohorts: 1750 patients were sedated with midazolam and fentanyl, and 1750 patients received propofol, in subanesthetic increments, in addition to midazolam and fentanyl. Initial sedation was established using midazolam and fentanyl in both subcohorts. The second subcohort received propofol during times of noxious stimulation. Patient exposure to 2 or more oxygen desaturations below 94% was uncommon. The variables that were significantly associated with low saturations were age, gender, and weight. Neither the dose of midazolam nor the additional use of propofol was a significant risk factor. ASA classification ( I or II) was not a determinant of risk. The data, within the limitations of the study, showed that a single operator/sedationist, supported by a well-trained team of nurses, can consistently maintain safe oxygen saturation levels. The additional use of propofol did not increase exposure to hypoxemia.

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“…Due to the confounding effect of the ASA class within the diverse populations in the previous reports, risk factors of hypoxemia within ASA I and II patients, who constitute the majority of ambulatory patients, are not well defined. Secondly, the relationships between body weight and hypoxemia have not been clearly defined in previous studies [8,12,13]. Therefore, our aims for this study were to evaluate the risk factors of hypoxemia in ASA I and II patients during moderate sedation for ambulatory endoscopic procedures and to evaluate the relationship between body mass index (BMI) and hypoxemia.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have evaluated the risk factors of hypoxemia in both retrospective and prospective methods with disparate results [4][5][6][7][8][9][10][11][12][13]. A majority of the reports found the American Society of Anesthesiology (ASA) classification to be the most significant overall risk factor.…”

Section: Introductionmentioning

confidence: 99%