Monitored Anesthesia Care with Propofol Versus Surgeon-Monitored Sedation with Benzodiazepines and Narcotics for Preoperative Endoscopy in the Morbidly Obese

Abstract

Patients who undergo upper endoscopy with either AMS or SMS seem to tolerate the procedure well. The preliminary benefits seen with AMS need to be further explored. AMS should be considered for patients undergoing preoperative upper endoscopy before bariatric surgery.

Preoperative Endoscopic Screening for Laparoscopic Roux-en-Y Gastric Bypass has a Low Yield for Anatomic Findings

“…EGD may carry a higher risk in the morbidly obese due to a high prevalence of sleep apnea and associated electrocardiograph abnormalities, together with lower baseline oxygen saturations and a higher probability for desaturation with sedation, although no sedation complications were observed in our study population [6][7][8]. However, alternatives to conventional EGD exist, such as transnasal upper endoscopy, which do not require sedation and may be utilized in the high-risk obese patient [21].…”

“…As the obese patient has a higher probability of respiratory decompensation and oxygen desaturation during sedation for EGD [7], it is important to assess whether the benefits of EGD outweigh the potential risks of the procedure in this patient group. Additional sedation issues for the morbidly obese include postprocedure nausea and vomiting, which can be lessened with anesthesiologist-administered propofol as compared to endoscopist-administered benzodiazepines [8]. Prior studies in the literature have suggested that significant findings are detected in approximately one third of patients undergoing preoperative EGD [9][10][11][12][13][14].…”

Is Preoperative Upper Gastrointestinal Endoscopy in Obese Patients Undergoing Bariatric Surgery Mandatory? An Asian Perspective

“…Morbidly obese patients are more likely to have concomitant diseases; diabetic obese patients may experience glycaemic complications due to the fasting for OGD. Those with obstructive sleep apnoea may be at higher risks of desaturation [21] and may benefit from monitored anaesthesia care [22]. Furthermore, incidental hiatus hernias uncovered during laparoscopic examination in a sleeve gastrectomy can be easily repaired with improvement in reflux symptoms postop [23].…”

Procedural sedation and obesity: waters left uncharted

“…Unfortunately, they do not give us any information regarding the ease of sedation and cardiopulmonary complications. Madan et al 25 found that monitored anesthesia care with propofol was equivalent to endoscopist-administered sedation with benzodiazepines and narcotics in a randomized trial of 100 morbidly obese subjects who underwent upper endoscopy in terms of pain, gagging, and recall. Again, there were no data reported on the type or incidence of cardiopulmonary complications.…”