Risk Factors for Hypoxemia During Ambulatory Gastrointestinal Endoscopy in ASA I–II Patients

Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, A 30, Cleveland, OH 44195, USA.
Digestive Diseases and Sciences (Impact Factor: 2.61). 11/2008; 54(5):1035-40. DOI: 10.1007/s10620-008-0452-2
Source: PubMed


Most studies identify the American Society of Anesthesiology (ASA) classification as the most significant risk factor for hypoxemia. The risk factors operative within ASA I and II patients are not well defined. Therefore, we analyzed prospectively collected data to identify the risk factors of hypoxemia in such patients.
A combination of a narcotic and benzodiazepine was used for sedation and oxygen was supplemented if hypoxemia (oxygen saturation <or=90%) developed. Univariate and multivariate analyses were performed and correlations estimated for predetermined clinical variables.
40 of 79 patients (51%) developed hypoxemia, which occurred more frequently in the obese (71%; 10/14) than the nonobese (46%; 30/65) group (P=0.08). On multivariate analysis, the odds ratios (OR) and 95% confidence intervals (CI) for developing hypoxemia were age >or= 60 years 4.5 (1.4-14.3) P=0.01, and incremental 25-mg doses of meperidine 2.6 (1.02-6.6) P = 0.04. Body mass index (BMI) significantly correlated with the number of hypoxemic episodes (rho 0.26, 95% CI 0.04-0.48, P=0.02).
In ASA I and II patients, BMI significantly correlated with the number of hypoxemic episodes, whereas age >or= 60 years and meperidine dose were significant risk factors for hypoxemia.

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Available from: Rocio Lopez, Dec 21, 2013
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    • "However, at least two studies have shown that obese patients run a higher perioperative risk for adverse airway events. In a prospective observational study involving 79 patients undergoing endoscopy under “conscious sedation,” Qadeer et al.[3] found a 51% overall incidence of hypoxemia (defined as saturation below 90% any time during the procedure, irrespective of the duration of hypoxia). They also found a significant difference in the rates of desaturation between non-obese (46%) and obese group (BMI >30 kg/m2 where it was 71%). "
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    ABSTRACT: 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. 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. 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. 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.
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    • "Hypoxemia is the most common cardiopulmonary adverse events (CAEs) that may cause morbidity and mortality during endoscopy procedures [8], [12], [13]. The reported risk factors for hypoxemia included high ASA scores, conscious sedation, obesity, old age of patient and function limitation of lung [4]–[9], [11]–[14]. "
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    ABSTRACT: Hypoxemia is the most common adverse event that happened during gastrointestinal endoscopy. To estimate risk of hypoxemia prior to endoscopy, American Society of Anesthesiology (ASA) classification scores were used as a major predictive factor. But the accuracy of ASA scores for predicting hypoxemia incidence was doubted here, considering that the classification system ignores much information about general health status and fitness of patient that may contribute to hypoxemia. In this retrospective review of clinical data collected prospectively, the data on 4904 procedures were analyzed. The Pearson's chi-square test or the Fisher exact test was employed to analyze variance of categorical factors. Continuous variables were statistically evaluated using t-tests or Analysis of variance (ANOVA). As a result, only 245 (5.0%) of the enrolled 4904 patients were found to present hypoxemia during endoscopy. Multivariable logistic regressions revealed that independent risk factors for hypoxemia include high BMI (BMI 30 versus 20, Odd ratio: 1.52, 95% CI: 1.13-2.05; P = 0.0098), hypertension (Odd ratio: 2.28, 95% CI: 1.44-3.60; P = 0.0004), diabetes (Odd ratio: 2.37, 95% CI: 1.30-4.34; P = 0.005), gastrointestinal diseases (Odd ratio: 1.77, 95% CI: 1.21-2.60; P = 0.0033), heart diseases (Odd ratio: 1.97, 95% CI: 1.06-3.68; P = 0.0325) and the procedures that combined esophagogastroduodenoscopy (EGD) and colonoscopy (Odd ratio: 4.84, 95% CI: 1.61-15.51; P = 0.0292; EGD as reference). It is noteworthy that ASA classification scores were not included as an independent predictive factor, and susceptibility of youth to hypoxemia during endoscopy was as high as old subjects. In conclusion, some certain pre-existing diseases of patients were newly identified as independent risk factors for hypoxemia during GI endoscopy. High ASA scores are a confounding predictive factor of pre-existing diseases. We thus recommend that youth (≤18 yrs), obese patients and those patients with hypertension, diabetes, heart diseases, or GI diseases should be monitored closely during sedation endoscopy.
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