Procedural sedation and obesity: waters left uncharted

Vargo, John J.

doi:10.1016/j.gie.2009.07.003

Cited by 37 publications

(31 citation statements)

References 40 publications

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“…Detaillierte Daten zur postprozeduralen Morbidität existieren nicht. Eine "Sedation Task Force" der American Association for the Study of Liver Disease (AASLD), des American College of Gastroenterology (ACG), der American Gastroenterological Association (AGA) und der American Society of Gastroenterological Endoscopy (ASGE) hat zur "Non-anesthesiological-administered propofol sedation (NAPS)" die Position vertreten, dass das Sicherheitsprofil von NAPS vergleichbar ist zur Standardsedierung, aber die Erfahrungen mit NAPS für die EUS und die ERCP bisher nicht ausreichend sind, um ein endgültiges Urteil abzugeben[111]. Im Jahr 2005 beantragte die AGA bei der Food and Drug Administration (FDA), dass Propofol nicht mehr nur durch Anästhesisten, sondern auch durch Nichtanästhesisten verabreicht werden dürfte.…”

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Update S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ 2014 (AWMF-Register-Nr. 021/014)

Riphaus¹,

Wehrmann²,

Hausmann

et al. 2015

Z Gastroenterol

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Update S3-Leitlinie "Sedierung in der gastrointestinalen Endoskopie" 2014 (AWMF-Register-Nr. 021/014) S3-guidelines "sedation in gastrointestinal endoscopy" 2014 (AWMF register no. 021/014) /6 11/57 72 12 Fax: ++ 49/6 11/57 74 60 5.2.1. Patienteninstruktionen 832 5.2.2. Minimalkriterien für die Entlassung 832 5.2.3. Verwendung von Score-Systemen für die Entlassung 832 5.3. "Street-Fitness" 833 5.3.1. Verkehrstauglichkeit 833 5.4. Dokumentation 834 5.4.1. Allgemeines 834 5.4.2. Arbeitsunfähigkeit 834 5.5. Benchmarking 834 6. Literatur 835 Riphaus A et al. Update S3-Leitlinie "Sedierung … Z Gastroenterol 2015; 53: 802-842 Leitlinie 803 Heruntergeladen von: NYU. Urheberrechtlich geschützt. ▶ Unterstützung der Dokumentation der Verläufe von im Rahmen der Sedierung auftretenden Komplikationen. ▶ Systematische Berücksichtigung der Empfehlungen in der Aus-, Fort-und Weiterbildung und in Qualitätsmanagement-systemen. Riphaus A et al. Update S3-Leitlinie "Sedierung … Z Gastroenterol 2015; 53: 802-842 Leitlinie 804 Heruntergeladen von: NYU. Urheberrechtlich geschützt. ▶ Etablierung einer Grundlage für inhaltlich gezielte ärztliche und pflegerische Aus-, Fort-und Weiterbildungsmaßnahmen. ▶ Systematische Berücksichtigung der Empfehlungen und daraus abgeleiteten Qualitätsindikatoren in der externen, vergleichenden Qualitätssicherung und Vereinheitlichung der Dokumentationsanforderungen. ▶ Flächendeckende Umsetzung einer qualitätsgesicherten Versorgung der Patienten während einer Sedierung im Rahmen der gastrointestinalen Endoskopie.▶ Optimierung der Patientensicherheit.In Ergänzung zu den bereits bestehenden Empfehlungen zur Sedierung in der gastrointestinalen Endoskopie durch Nicht-Anäs-thesisten, die in die Erstellung der Sedierungsleitlinie 2008 eingeflossen waren [6], und auch der unten aufgeführten aktuellen Quell-Leitlinien, sowie zu den weiteren o. g. Projekten und Maß-nahmen soll langfristig die Patientensicherheit sichergestellt werden.

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unclassified

Update S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ 2014 (AWMF-Register-Nr. 021/014)

Riphaus¹,

Wehrmann²,

Hausmann

et al. 2015

Z Gastroenterol

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“…It is postulated that obese patients have a high prevalence of obstructive sleep apnea [10, 11] and propofol accentuates airway collapse as patients become unresponsive to verbal stimulation potentially increasing the risk of cardiopulmonary adverse events [12]. In addition, patients with morbid obesity can have restrictive lung disease, pulmonary hypertension and development of significant alveolar-to-arterial oxygen gradients [13]. Data on the association of obesity and sedation related outcomes in patients undergoing advanced endoscopy is limited; specifically defining the frequency of adverse events in the setting of a BMI ≥ 30 kg/m 2 .…”

Section: Introductionmentioning

confidence: 99%

Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures

Wani

Azar

Hovis

et al. 2011

Gastrointestinal Endoscopy

117

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Background There is limited data on the safety of anesthesia-assisted endoscopy using propofol-mediated sedation in obese individuals undergoing advanced endoscopic procedures (AEPs). Objective To study the association between obesity [as measured by body mass index (BMI)] and the frequency of sedation-related complications (SRCs) in patients undergoing AEPs. Design Prospective cohort study. Setting Tertiary referral center. Patients 1016 consecutive patients undergoing AEPs [BMI<30: 730(72%), 30-35:159(16%), >35:127(12%)]. Intervention Monitored anesthesia sedation with propofol alone or in combination with benzodiazepines and/or opioids. Main Outcome Measures SRCs: airway modifications (AMs), hypoxemia, hypotension requiring vasopressors, and early procedure termination were compared across three groups. Results There were 203 AMs in 13.9% patients, hypoxemia in 7.3%, need for vasopressors in 0.8% and premature termination in 0.6% of patients. Increasing BMI was associated with an increased frequency of AMs (BMI:<30–10.5%, 30-35–18.9%, >35–26.8%, p<0.001) and hypoxemia (<30–5.3%, 30-35–9.4%, >35–13.4%, p=0.001); there was no difference in the frequency of need for vasopressors (p=0.254) and premature termination of procedures (p=0.401). On multivariable analysis, BMI [OR 2.0 (95% CI 1.3-3.1)], age [OR 1.1 (95% CI 1.0-1.1)] and ASA class ≥ 3 [OR 2.4 (95% CI 1.1-5.0)] were independent predictors of SRCs. In obese individuals (n=286), there was no difference in the frequency of SRCs in patients receiving propofol alone or in combination (p=0.48). Limitations Single tertiary center study. Conclusions Although obesity was associated with an increased frequency of SRCs, propofol sedation can be used safely in obese patients undergoing AEPs when administered by trained professionals.

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“…However, existing data specifically pertaining to endoscopy safety in obese patients are sparse [10], and there are no evidence-based guidelines addressing whether BMI should be considered an independent risk factor for CAEs for ASA class I and II patients with BMI 30–40 for outpatient colonoscopy when comorbidities such as OSA are absent. This is the first study aimed to evaluate the independent effect of BMI on CAEs in obese and morbidly obese patients for outpatient colonoscopy, as well as to characterize the type of CAEs that occurred and whether interventions were required as a measure of clinical significance.…”

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea Increases the Risk of Cardiopulmonary Adverse Events Associated with Ambulatory Colonoscopy Independent of Body Mass Index

et al. 2017

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Background The relationship between body mass index (BMI) and cardiopulmonary adverse events (CAEs) for ambulatory colonoscopy is unclear. Aim To assess the association of BMI and CAEs associated with ambulatory colonoscopy. Methods This is a retrospective cohort analysis of 418 patients who underwent outpatient colonoscopy at the Durham Veterans Affairs Medical Center categorized as normal/overweight (BMI < 30), obese (BMI 30–34), or morbidly obese (BMI ≥ 35). Adjusted logistic regression analyses were performed. Results At least one CAE occurred in 46.4% of patients (220 events, 72.7% were hypoxia). The rate of CAEs (BMI < 30: 43.8%, BMI 30–34: 48.0%, BMI ≥ 35: 50.6%, p = 0.53) and rate of hypoxia (BMI < 30: 34.8%, BMI 30–34: 40.9%, BMI ≥ 35: 43.2%, p = 0.32) were numerically higher for obese and morbidly obese patients, but not statistically significant. Obese (OR 1.10, 95% CI 0.70–1.73) and morbidly obese (OR 1.07, 95% CI 0.61–1.85) patients did not have an increased risk of CAEs after adjusting for age, ASA class, obstructive sleep apnea (OSA), and type of sedation. OSA was independently associated with an increased risk of CAEs (OR 1.71, 95% CI 1.09–2.74, p = 0.02) after adjusting for BMI, age, ASA class, and type of sedation. Conclusion OSA confers a higher risk of CAEs independent of BMI and sedation type. Consideration of undiagnosed OSA is recommended for appropriate pre-procedure risk stratification. While not statistically significant in this study, there may be clinically significant increased risks of CAEs and hypoxia for patient with BMI > 30 that require further evaluation with larger studies.

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Procedural sedation and obesity: waters left uncharted

Cited by 37 publications

References 40 publications

Update S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ 2014 (AWMF-Register-Nr. 021/014)

Update S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ 2014 (AWMF-Register-Nr. 021/014)

Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures

Obstructive Sleep Apnea Increases the Risk of Cardiopulmonary Adverse Events Associated with Ambulatory Colonoscopy Independent of Body Mass Index

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