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

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/m2 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.

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

“…This supports previous studies of endoscopic procedures that found increased risks associated with OSA rather than with BMI [9, 12]. Previous studies have mixed results regarding type of sedation (administered by anesthesia or not) and risk of CAEs [11, 12]. While our study was not powered to examine this issue directly, univariate analyses did not demonstrate a statistically significant difference in CAE risk between MAC versus MS.…”

“…OSA did confer a higher risk of CAEs, with a trend toward a risk of requiring an intervention performed as well. This supports previous studies of endoscopic procedures that found increased risks associated with OSA rather than with BMI [9, 12]. Previous studies have mixed results regarding type of sedation (administered by anesthesia or not) and risk of CAEs [11, 12].…”

“…A logistic regression model was built for two binary outcomes: (1) the occurrence of CAEs and (2) the need for intervention for CAEs. Model covariates were selected based on the results of univariate analyses and existing literature [6, 7, 12, 13]. Logistic regression model covariates included: (1) BMI, (2) type of sedation, (3) age, (4) ASA class [20], (5) and OSA.…”

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

“…It is, therefore, recommended that CPAP (beginning from 5 to 7.5 cm of water) should be used in preference to oxygen therapy alone, in particular in patients with OSA and signs of respiratory deterioration. Several retrospective analyses evaluating prophylactic CPAP use have not demonstrated a clear benefit in oxygenation [212,213]. ''Super obese'' patients (BMI [60 kg/ m 2 ), with complications requiring reoperation may be considered for prophylactic CPAP as these patients often need prolonged respiratory support [214].…”

Controversies in Perioperative Anesthetic Management of the Morbidly Obese: I Am a Surgeon, Why Should I Care?

“…Most studies suggest that the comorbidities indirectly associated with obesity, rather than obesity itself, increases the risks in same day surgeries. Clinical trials report a statistically significant higher incidence in respiratory events (oxygen desaturation, bronchospasm, stridor/laryngospasm, airway obstruction) and need for oxygen supplementation in obese patients [60,61]. However, these studies did not report an increase in unanticipated admission rates in obese patients, suggesting that the respiratory events which are a direct consequence of obesity may not be clinically significant [58].…”