The safety of endoscopic esophageal procedures under general anesthesia

Kim, Go Eun; Kim, Duk Kyung; Choi, Ji Won; Chung, In Sun; Jung, Da Woon

doi:10.4097/kjae.2017.70.5.555

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…Studies show that aspiration in patients with liver cirrhosis can be minimized during any endoscopic intervention by using safety measures. 22,23 Limitations of the Study: The study demonstrated a high mortality rate primarily contributed by tracheobronchial aspiration, while no other reasons were studied which remains the major limitation of the present study. There may be other possible reasons than the ones studied (age, gender and occurrence of tracheobronchial aspiration) that need to be investigated.…”

Section: Discussionmentioning

confidence: 83%

Tracheobronchial aspiration affects the outcome of hospitalization among Hepatic Encephalopathy patients

Rafiq

Zeeshan²,

Mustafa

et al. 2022

Pak J Med Sci

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Objectives: The present study aimed to determine the effect of tracheobronchial aspiration on hospitalization outcomes and the factors influencing its occurrence. Methods: This prospective descriptive study was conducted from January 2017 to December 2020 at GMC/DHQ-Teaching Hospital in Gujranwala, Pakistan. All consenting liver cirrhosis patients with hepatic encephalopathy > 12 years of age admitted at the study site were included. The patient’s baseline characteristics and the hospitalization outcomes were noted in terms of death and discharge. The collected data was analyzed using SPSS version 22.0. The predictors of tracheobronchial aspiration were determined using Independent Sample T test and Chi-square test for quantitative and qualitative variables respectively. The p-values were taken statistically significant if < 0.05. A binary logistic regression analysis was performed to ascertain the effect of significant factors on the likelihood of tracheobronchial aspiration. Results: Among the total of 294 patients, 28.0% died during hospitalization. Death occurred significantly more in group of patients who had tracheobronchial aspiration (62.7% vs 12.0%, p<0.01). Increasing age was associated with increased chance of tracheobronchial aspiration (p<0.01). Male gender (49.6% vs 8.2%, p<0.01), patients whose hepatic encephalopathy was precipitated by upper GI bleed (59.7% vs 22.9%, p<0.01), and patients with comorbidities (p=0.02) were significantly prone to tracheobronchial aspiration. Conclusions: Tracheobronchial aspiration is a significant predictor of inpatient mortality among patients with hepatic encephalopathy. Male gender, increasing age & upper GI bleed predict aspiration in hepatic encephalopathy patients. doi: https://doi.org/10.12669/pjms.38.4.5114 How to cite this:Rafiq Q, Zeeshan M, Mustafa G, Irfan M. Tracheobronchial aspiration affects the outcome of hospitalization among Hepatic Encephalopathy patients. Pak J Med Sci. 2022;38(4):---------. doi: https://doi.org/10.12669/pjms.38.4.5114 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 83%

Tracheobronchial aspiration affects the outcome of hospitalization among Hepatic Encephalopathy patients

Rafiq

Zeeshan²,

Mustafa

et al. 2022

Pak J Med Sci

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“…Secondly, tracheobronchial aspiration is observed during massive upper GI bleed which can be prevented by intubating17-20 patients if bleeding patients suddenly collapse. Some cirrhotic patients exhibit aspiration during endoscopic interventions21 which can also be minimized by adequate safety measures 22,23. Mortality from liver diseases is one of the leading cause of death in our country.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting the outcome of hospitalization among liver cirrhosis patients

et al. 2019

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Objectives: To determine the factors affecting the outcome of hospitalization in patients suffering liver cirrhosis hospitalized to tertiary care hospital, Gujranwala, Pakistan. Methods: After informed consent, the data of liver cirrhosis patients with age >12 years hospitalized from June 2016 to May 2017 was collected by purposive sampling. The outcome of the hospitalization in term of ‘death’ and ‘no death’ was noted. Statistical analysis was done using SPSS version 25. Bivariate analysis as well binary logistic regression was performed to ascertain the effect of different predictors like gender, age, history of diabetes mellitus, etiology of cirrhosis, presence of hepatic encephalopathy at presentation, presence of upper GI bleed, and tracheobronchial aspiration on the likelihood that death would be the outcome in liver cirrhosis patients. Results: Amongst total of 1304 patients, 15.7% died during hospitalization. The mean age of those who died was 58.08 + 14.49 years. Bivariate analysis suggested that mortality was significantly higher in group of patients who had hepatic encephalopathy at presentation (p<0.01), no upper gi bleed (p<0.01), and who got tracheobronchial aspiration during hospitalization (p<0.01). It did not differ significantly in male/female gender (p=0.504), diabetic/non-diabetic groups (p=0.652), with viral/non-viral etiology of cirrhosis (p=0.918). Binary logistic regression revealed that patients who had tracheobronchial aspiration were 12.392 times more likely to die than who had no tracheobronchial aspiration. Similarly, patients who presented in hepatic encephalopathy were 7.862 times more likely to die than who presented without hepatic encephalopathy. Conclusion: The inpatient mortality rate amongst cirrhotic patients was high. Age, gender, history of diabetes, viral etiology of cirrhosis did not significantly contribute in the mortality of these patients. The patients who presented in hepatic encephalopathy, and who suffered tracheobronchial aspiration during hospitalization were more likely to die. Excellence in hepatic encephalopathy management and prevention from aspiration can effectively reduce the mortality rate of cirrhotic patients in our hospitals. doi: https://doi.org/10.12669/pjms.35.5.884 How to cite this:Irfan M, Mahmud Y, Khan RMS, Rafiq Q, Nadeem MA, Mohsin A. Factors affecting the outcome of hospitalization among liver cirrhosis patients. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.884 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…Currently, efforts are being made to provide anesthesia services in the endoscopic unit. Aside from sedation for EGD, general anesthesia is also being offered in the endoscopic unit by a dedicated team of anesthesiologists with extensive experience in gastrointestinal endoscopy [47]. Yang et al [13] supported the feasibility of POEM performed by an endoscopist in the endoscopic unit.…”

Section: Future Of Anesthetic Management For Poemmentioning

confidence: 99%

Anesthetic Consideration for Peroral Endoscopic Myotomy

Bang

Park

2019

Clin Endosc

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A recent achalasia guideline suggests that peroral endoscopic myotomy (POEM) is a safe option for achalasia that is as effective as Heller myotomy. It is recommended that POEM should be performed under general anesthesia. The incidence of adverse events such as bleeding, perforation, and carbon dioxide insufflation-related complications was lower in POEM under endotracheal general anesthesia than in POEM under sedation. Subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumoperitoneum, and accompanying hemodynamic instability can be caused by carbon dioxide insufflation. Treatment of possible physiological changes and adverse events during the POEM procedure from the point of view of anesthesiologists may give endoscopists a new perspective on improving patient safety. The territory of therapeutic endoscopy can be expanded through cooperation with other departments, including anesthesia services. Efforts to understand different perspectives will certainly help not only secure patient safety but also expand the area of treatment.

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The safety of endoscopic esophageal procedures under general anesthesia

Cited by 4 publications

References 18 publications

Tracheobronchial aspiration affects the outcome of hospitalization among Hepatic Encephalopathy patients

Tracheobronchial aspiration affects the outcome of hospitalization among Hepatic Encephalopathy patients

Factors affecting the outcome of hospitalization among liver cirrhosis patients

Anesthetic Consideration for Peroral Endoscopic Myotomy

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