Airway Management Considerations for Upper Gastrointestinal Endoscopic Procedures in COVID-19 Era

Thiruvenkatarajan, Venkatesan; Lorenzetti, Mark; Chung, Adrian; Wong, Carlos King Ho; Currie, John; Wahba, Medhat; Wijk, Roelof Van; Skinner, M. W.; Sorbello, Massimiliano

doi:10.1007/s10620-020-06478-x

Cited by 3 publications

(3 citation statements)

References 20 publications

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Section: Discussionmentioning

confidence: 99%

“…Moreover, because of its convenience, unrestricted to special instruments and manipulation position far away from the oropharyngeal airway, MMCC could also be urgently applied in other perioperative situations involving oxygen desaturation events particularly with shortage or dysfunction of rescue devices, especially in COVID-19 era. 24 The protective mechanisms of MMCC were still unclear, which might be considered by the following probable potential factors. First, thorax compression could induce contraction of the diaphragm and movement of respiratory muscles, which generate negative intrathoracic pressure and passively promote lung expansion.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Modified Manual Chest Compression for Prevention and Treatment of Respiratory Depression in Patients Under Deep Sedation During Upper Gastrointestinal Endoscopy: Two Randomized Controlled Trials

Wei

Shen

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: We aimed to determine the preventive and therapeutic efficacy of modified manual chest compression (MMCC), a novel noninvasive and device-independent method, in reducing oxygen desaturation events in patients undergoing upper gastrointestinal endoscopy under deep sedation. METHODS: A total of 584 outpatients who underwent deep sedation during upper gastrointestinal endoscopy were enrolled. In the preventive cohort, 440 patients were randomized to the MMCC group (patients received MMCC when their eyelash reflex disappeared, M1 group) or control group (C1 group). In the therapeutic cohort, 144 patients with oxygen desaturation of a Spo 2 < 95% were randomized to MMCC group (patients who subsequently received MMCC, M2 group) or the conventional treatment group (C2 group). The primary outcomes were the incidence of desaturation episodes with an Spo 2 < 95% for the preventive cohort and the time spent below 95% Spo 2 for the therapeutic cohort. Secondary outcomes included the incidence of gastroscopy withdrawal and diaphragmatic pause. RESULTS: In the preventive cohort, MMCC reduced the incidence of desaturation episodes <95% (14.4% vs 26.1%; RR, 0.549; 95% confidence interval [CI], 0.37–0.815; P = .002), gastroscopy withdrawal (0% vs 2.29%; P = .008), and diaphragmatic pause at 30 seconds after propofol injection (74.5% vs 88.1%; RR, 0.846; 95% CI, 0.772–0.928; P < .001). In the therapeutic cohort, patients who received MMCC had a significantly shorter time spent below 95% Spo 2 (40 [20–69] seconds vs 91 [33–152] seconds, median difference [95% CI], −39 [−57 to −16] seconds, P < .001), a lower incidence of gastroscopy withdrawal (0% vs 10.4%, P = .018), and more enhanced diaphragmatic movement at 30 seconds after Spo 2 <95% (1.11 [0.93–1.4] cm vs 1.03 [0.7–1.24] cm; median difference [95% confidence interval], 0.16 [0.02–0.32] cm; P = .015). CONCLUSIONS: MMCC may exert preventive and therapeutic effects against oxygen desaturation events during upper gastrointestinal endoscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Modified Manual Chest Compression for Prevention and Treatment of Respiratory Depression in Patients Under Deep Sedation During Upper Gastrointestinal Endoscopy: Two Randomized Controlled Trials

Wei

Shen

et al. 2023

Anesthesia &Amp; Analgesia

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“…In the coronavirus disease 2019 era, prevention of aerosol exposure was an important concern, and securing the airway using the LGA along with a viral filter was suggested as a useful alternative for UGIE procedures under GA.[ 12 ] The advantage of the LGA in this situation is that it provides a near-complete seal of the oropharynx and reduces the need for intra-procedural airway manipulations. [ 4 6 9 ]…”

Section: Introductionmentioning

confidence: 99%

LMA gastro for gastro-intestinal endoscopic procedures: Pearls, pitfalls, and troubleshoots of its usage

Gupta¹,

Parida²,

Subramaniam³

et al. 2022

Indian Journal of Anaesthesia

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A new device, LMA Gastro™, on the horizon for endoscopy procedures: A narrative review

Gupta,

Saranlal,

Gupta

2024

Journal of Anaesthesiology Clinical Pharmacology

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Interventional endoscopy procedures are challenging for anaesthesiologists due to the various patient, procedural, logistic, and position-related issues. Complex endoscopic procedures like biliary interventions and endoscopic myotomy necessitate longer procedural duration. The mode of anaesthesia is usually deep sedation without any definitive airway device and is frequently associated with hypoxemia events which can be catastrophic. An endotracheal tube, though the gold standard for securing the airway, would prolong the anaesthesia time and delay the recovery. The laryngeal mask airway Gastro™ is a novel supraglottic airway device specifically meant for these procedures as it provides access to the gastrointestinal tract simultaneously with a patent airway. Though its purported advantages are undoubted, its clinical usage has various pitfalls that can hinder its wider acceptance and practical utility, especially when newly introduced. The literature is limited on the feasibility of this device in both the ease of endoscopy and the prevention of hypoxemia. In this review, we have discussed the device’s properties, its varied use cases, the supporting evidence for the same, the caveats, and the future perspectives.

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Airway Management Considerations for Upper Gastrointestinal Endoscopic Procedures in COVID-19 Era

Cited by 3 publications

References 20 publications

Modified Manual Chest Compression for Prevention and Treatment of Respiratory Depression in Patients Under Deep Sedation During Upper Gastrointestinal Endoscopy: Two Randomized Controlled Trials

Modified Manual Chest Compression for Prevention and Treatment of Respiratory Depression in Patients Under Deep Sedation During Upper Gastrointestinal Endoscopy: Two Randomized Controlled Trials

LMA gastro for gastro-intestinal endoscopic procedures: Pearls, pitfalls, and troubleshoots of its usage

A new device, LMA Gastro™, on the horizon for endoscopy procedures: A narrative review

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