Goudra Basavana Gouda, Singh Preet Mohinder, Penugonda Lakshmi C, Speck Rebecca M, Sinha Ashish C
Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
J Anaesthesiol Clin Pharmacol. 2014 Jan;30(1):71-7. doi: 10.4103/0970-9185.125707.
Providing anesthesia for gastrointestinal (GI) endoscopy procedures in morbidly obese patients is a challenge for a variety of reasons. The negative impact of obesity on the respiratory system combined with a need to share the upper airway and necessity to preserve the spontaneous ventilation, together add to difficulties.
This retrospective cohort study included patients with a body mass index (BMI) >40 kg/m(2) that underwent out-patient GI endoscopy between September 2010 and February 2011. Patient data was analyzed for procedure, airway management technique as well as hypoxemic and cardiovascular events.
A total of 119 patients met the inclusion criteria. Our innovative airway management technique resulted in a lower rate of intraoperative hypoxemic events compared with any published data available. Frequency of desaturation episodes showed statistically significant relation to previous history of obstructive sleep apnea (OSA). These desaturation episodes were found to be statistically independent of increasing BMI of patients.
Pre-operative history of OSA irrespective of associated BMI values can be potentially used as a predictor of intra-procedural desaturation. With suitable modification of anesthesia technique, it is possible to reduce the incidence of adverse respiratory events in morbidly obese patients undergoing GI endoscopy procedures, thereby avoiding the need for endotracheal intubation.
由于多种原因，为病态肥胖患者的胃肠道（GI）内镜检查提供麻醉是一项挑战。肥胖对呼吸系统的负面影响，加上需要共享上呼吸道以及保持自主通气的必要性，共同增加了困难。
这项回顾性队列研究纳入了2010年9月至2011年2月间接受门诊GI内镜检查、体重指数（BMI）>40 kg/m²的患者。分析患者的手术、气道管理技术以及低氧血症和心血管事件的数据。
共有119名患者符合纳入标准。与现有任何已发表数据相比，我们创新的气道管理技术使术中低氧血症事件发生率更低。去饱和事件的频率与既往阻塞性睡眠呼吸暂停（OSA）病史存在统计学显著关联。发现这些去饱和事件在统计学上与患者BMI增加无关。
无论相关BMI值如何，OSA的术前病史都有可能用作术中去饱和的预测指标。通过适当修改麻醉技术，有可能降低接受GI内镜检查的病态肥胖患者不良呼吸事件的发生率，从而避免气管插管的需要。
