Sedation for Bronchoscopy and Complications in Obese Patients

Abstract

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.

Impact of class III obesity on outcomes and complications of transvaginal ultrasound-guided oocyte pickup

“…The literature on outcomes of conscious sedation among obese women is limited. Our observation of an increase in fentanyl and midazolam dose associated with increasing BMI is in keeping with two studies of other procedures using conscious sedation including bronchoscopy and firsttrimester surgical abortion (11,12). Similarly, an increase in propofol dose has been observed with increasing BMI in endoscopy under deep sedation (13), as well as OPUs for IVF under total intravenous anesthesia (9).…”

Level and predictors of anxiety in patients undergoing diagnostic bronchoscopy

“…In another study by Khan et al ., they did not find any clinically significant difference in sedation needs or an increase in complications in obese versus nonobese patients. [22] The association between anxiety and obesity is contradicting. [23] There is moderate evidence that shows obesity is positively associated with anxiety.…”

Is the Mallampati Score Useful for Emergency Department Airway Management or Procedural Sedation?

“…The few existing studies of Mallampati score for procedural sedation are inadequate and inconclusive. 22,[44][45][46] In their most recent procedural sedation policy, the American College of Emergency Physicians (ACEP) concluded that "[t]here is no evidence that the addition of the Mallampati score to a standard general evaluation of the anatomic or physiologic variants.has any impact on clinical outcomes during sedation, and thus it cannot be recommended." 61 In conclusion, the literature evidence demonstrates that the Mallampati score is inadequately sensitive for the identification of difficult laryngoscopy, difficult intubation, and difficult bag-valve-mask ventilation, with likelihood ratios indicating a small and clinically insignificant effect on outcome prediction.…”