Predictive factors of oxygen desaturation during upper gastrointestinal endoscopy in nonsedated patients

Alcaín, Guillermo; Guillén, Pablo; Escolar, Antonio; Moreno, Miguel; Martín, Leopoldo

doi:10.1016/s0016-5107(98)70155-5

Cited by 37 publications

(20 citation statements)

References 21 publications

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“…In einer vergleichenden Studie von Smith et al[328] zur Funktionstüchtigkeit von Schmetterlingskanülen (Butterfly) und Venenverweilkanüle 1 Stunde nach erfolgter Endoskopie, also einem Zeitraum, in dem die Halbwertszeit der meisten Benzodiazepine und Opiate nicht einmal erreicht ist, waren nur noch 44 % der Schmetterlingskanülen, aber 98 % der Venenverweilkanülen noch funktionstüchtig.AnmerkungZwischenfälle, die auf eine Sedierung zurückzuführen sind, sind in erster Linie kardiopulmonale Ereignisse[319]. Diese umfassen etwa die Hälfte aller Komplikationen in der Endoskopie und können je nach vorbestehendem Risiko des Patienten bei Gastroskopien auch ohne Sedierung auftreten[329]. Die Häufigkeit kardiopulmonaler Ereignisse wird in der älteren Literatur und unter Verwendung von Benzodiazepinen um 5 %[179] und in neueren Studien zu Propofol um 0,1 %[20] beziffert.…”

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Update S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ 2014 (AWMF-Register-Nr. 021/014)

Riphaus¹,

Wehrmann²,

Hausmann

et al. 2015

Z Gastroenterol

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Update S3-Leitlinie "Sedierung in der gastrointestinalen Endoskopie" 2014 (AWMF-Register-Nr. 021/014) S3-guidelines "sedation in gastrointestinal endoscopy" 2014 (AWMF register no. 021/014) /6 11/57 72 12 Fax: ++ 49/6 11/57 74 60 5.2.1. Patienteninstruktionen 832 5.2.2. Minimalkriterien für die Entlassung 832 5.2.3. Verwendung von Score-Systemen für die Entlassung 832 5.3. "Street-Fitness" 833 5.3.1. Verkehrstauglichkeit 833 5.4. Dokumentation 834 5.4.1. Allgemeines 834 5.4.2. Arbeitsunfähigkeit 834 5.5. Benchmarking 834 6. Literatur 835 Riphaus A et al. Update S3-Leitlinie "Sedierung … Z Gastroenterol 2015; 53: 802-842 Leitlinie 803 Heruntergeladen von: NYU. Urheberrechtlich geschützt. ▶ Unterstützung der Dokumentation der Verläufe von im Rahmen der Sedierung auftretenden Komplikationen. ▶ Systematische Berücksichtigung der Empfehlungen in der Aus-, Fort-und Weiterbildung und in Qualitätsmanagement-systemen. Riphaus A et al. Update S3-Leitlinie "Sedierung … Z Gastroenterol 2015; 53: 802-842 Leitlinie 804 Heruntergeladen von: NYU. Urheberrechtlich geschützt. ▶ Etablierung einer Grundlage für inhaltlich gezielte ärztliche und pflegerische Aus-, Fort-und Weiterbildungsmaßnahmen. ▶ Systematische Berücksichtigung der Empfehlungen und daraus abgeleiteten Qualitätsindikatoren in der externen, vergleichenden Qualitätssicherung und Vereinheitlichung der Dokumentationsanforderungen. ▶ Flächendeckende Umsetzung einer qualitätsgesicherten Versorgung der Patienten während einer Sedierung im Rahmen der gastrointestinalen Endoskopie.▶ Optimierung der Patientensicherheit.In Ergänzung zu den bereits bestehenden Empfehlungen zur Sedierung in der gastrointestinalen Endoskopie durch Nicht-Anäs-thesisten, die in die Erstellung der Sedierungsleitlinie 2008 eingeflossen waren [6], und auch der unten aufgeführten aktuellen Quell-Leitlinien, sowie zu den weiteren o. g. Projekten und Maß-nahmen soll langfristig die Patientensicherheit sichergestellt werden.

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unclassified

Update S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ 2014 (AWMF-Register-Nr. 021/014)

Riphaus¹,

Wehrmann²,

Hausmann

et al. 2015

Z Gastroenterol

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“…However, oxygen desaturation was rare in our unsedated patients, and SpO 2 levels dropped below 90% in only 2% of cases. Previous small studies have reported that SpO 2 levels are relatively unaffected by endoscope insertion or the endoscopic examination in unsedated patients (9,10), while others found that between 6% and 9% of patients desaturate to less than 90% during unsedated procedures (12,13,19). These apparently con icting results may have arisen because of methodological differences between studies.…”

Section: Discussionmentioning

confidence: 98%

“…Although a large number of studies have assessed SpO 2 levels during sedated endoscopy, few have measured SpO 2 levels in patients undergoing examination without sedation (9)(10)(11)(12)(13). Those studies which have been performed have been relatively small (9)(10)(11)(12).…”

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Pulse Oximetry Saturation Levels during Routine Unsedated Diagnostic Upper Gastrointestinal Endoscopy

Banks¹

2001

Scandinavian Journal of Gastroenterology

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Banks MR, Kumar PJ, Mulcahy HE. Pulse oximetry saturation levels during routine unsedated diagnostic upper gastrointestinal endoscopy. Scand J Gastroenterol 2001;36:105-109.Background: Diagnostic procedures account for over 90% of all upper gastrointestinal endoscopies. Pulse oximetry saturation (SpO 2 ) levels were assessed in patients attending for routine unsedated diagnostic gastroscopy to identify factors associated with oxygen desaturation. Methods: Three hundred and thirty unsedated patients were monitored with continuous pulse oximetry. A further 154 patients who requested sedation prior to endoscopy were studied as a positive control group. Results: SpO 2 levels were lower in sedated compared to unsedated patients (P < 0.0001). Six unsedated patients (2%) desaturated to 90% or less during endoscopy compared to 32 sedated patients (21%) (P < 0.0001). SpO 2 levels in unsedated patients were not related to patient sex, age, cigarette smoking, endoscope diameter, basal SpO 2 levels or duration of endoscopy. In contrast, examination of the pharyngeal area and epiglottis (P = 0.0002) and a longer intubation time (P = 0.0002) were associated with lower SpO2 levels. The lowest SpO2 level recorded during unsedated endoscopy was 88%. Conclusion: Pulse oximetry is not a prerequisite to performing routine unsedated diagnostic gastroscopy in patients without severe systemic disease.

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“…16,17 Patients with a baseline oxygen saturation of <95% are at risk of respiratory complications under sedation and require very close monitoring. 19,20 Although oxygen desaturation can be readily assessed using pulse oximetry, this tool is relatively insensitive for detecting hypoventilation because oxygen desaturation is a late sign of depressed ventilation ( Figure 2). A limitation of pulse oximetry is its inability to detect an adequate signal as a consequence of hypothermia, low cardiac output or motion artifacts.…”

Section: Pulse Oximetrymentioning

confidence: 99%

How best to approach endoscopic sedation?

Müller

Wehrmann

2011

Nat Rev Gastroenterol Hepatol

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Sedation is the drug-induced reduction of a patient's consciousness. The aim of sedation in endoscopic procedures is to increase the patient's comfort and to improve endoscopic performance, especially in therapeutic procedures. The most commonly used sedation regimen for conscious sedation in gastrointestinal endoscopy is still the combination of benzodiazepines with opioids. However, the use of propofol has increased enormously in the past decade and several studies show advantages of propofol over the traditional regimes in terms of faster recovery time. It is important to be aware that the complication rate of endoscopies increases when sedation is used; therefore, a thorough risk evaluation before the procedure and monitoring during the procedure must be performed. In addition, properly trained staff and emergency equipment should be available. The best approach to sedation in endoscopy is to choose a sedation regimen for the individual patient, tailored according to the clinical risk assessment and the anxiety level of the patient, as well as to the type of planned endoscopic procedure.

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Predictive factors of oxygen desaturation during upper gastrointestinal endoscopy in nonsedated patients

Cited by 37 publications

References 21 publications

Update S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ 2014 (AWMF-Register-Nr. 021/014)

Update S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ 2014 (AWMF-Register-Nr. 021/014)

Pulse Oximetry Saturation Levels during Routine Unsedated Diagnostic Upper Gastrointestinal Endoscopy

How best to approach endoscopic sedation?

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