Pre-Existing Diseases of Patients Increase Susceptibility to Hypoxemia during Gastrointestinal Endoscopy

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.

Dexmedetomidine provides less body motion and respiratory depression during sedation in double-balloon enteroscopy than midazolam

“… 21 – 23 However, other articles reported on other risk factors, such as diabetes, which were not significant factors in this study. 24 …”

Sedation-related complications in gastrointestinal endoscopy

“…Multivariable logistic regressions revealed that independent risk factors for hypoxemia include high body mass index, hypertension, diabetes, gastrointestinal diseases, heart diseases and procedures that combined esophagogastroduodenoscopy (EGD) and colonoscopy [32] . Hypoxemia occurs typically within 5 min of medication administration or endoscope intubation and only one third of all apnea and abnormal ventilation events eventually lead to hypoxemia [31] .…”

Usefulness of Acoustic Monitoring of Respiratory Rate in Patients Undergoing Endoscopic Submucosal Dissection

“…In fact, we used it to measure the incidence of respiratory suppression in patients undergoing ESD and to assess the risk factors for respiratory suppression in these patients. Previous studies have shown that the incidence of respiratory suppression in patients undergoing gastrointestinal endoscopic treatment under conscious sedation ranges from 10 to 70%, depending on the definition of respiratory suppression, patient population, type of endoscopy, and type of sedatives [ 9 , 10 ]. Markedly, in these studies, pulse oximetrywas used as a surrogate measure of ventilation.…”