Section of vital functions, Department of Anesthesiology, UMC Utrecht, Heidelberglaan 100, Utrecht, The Netherlands.
Department of Anesthesiology, Cantonal Hospital Aarau, Aarau, Switzerland.
Can J Anaesth. 2021 Sep;68(9):1349-1357. doi: 10.1007/s12630-021-01992-6. Epub 2021 Apr 20.
Since 2010, new guidelines for procedural sedation and the Helsinki Declaration on Patient Safety have increased patient safety, comfort, and acceptance considerably. Nevertheless, the administration of sedatives and opioids during sedation procedures may put the patient at risk of hypoxemia. However, data on hypoxemia during procedural sedation are scarce. Here, we studied the incidence and severity of hypoxemia during procedural sedations in our hospital.
A historical, single-centre cohort study was performed at the University Medical Centre Utrecht (UMCU), a tertiary centre in the Netherlands. Data from procedural sedation in our hospital between 1 January 2011 and 31 December 2018 (3,459 males and 2,534 females; total, 5,993) were extracted from our Anesthesia Information Management System. Hypoxemia was defined as peripheral oxygen saturation < 90% lasting at least two consecutive minutes. The severity of hypoxemia was calculated as area under the curve. The relationship between the severity of hypoxemia and body mass index (BMI), American Society of Anesthesiologists (ASA) Physical Status classification, and duration of the procedure was investigated. The primary outcome was the incidence of hypoxemia.
Twenty-nine percent of moderately to deeply sedated patients developed hypoxemia. A high incidence of hypoxemia was found in patients undergoing procedures in the heart catheterization room (54%) and in patients undergoing bronchoscopy procedures (56%). Hypoxemia primarily occurred in longer lasting procedures (> 120 min) and especially in the latter phases of the procedures. There was no relationship between severity of hypoxemia and BMI or ASA Physical Status.
This study showed that a considerable number of patients are at risk of hypoxemia during procedural sedation with a positive correlation shown with increasing duration of medical procedures. Additional prospective research is needed to investigate the clinical consequences of this cumulative hypoxemia.
自 2010 年以来，新的程序性镇静指南和《赫尔辛基患者安全宣言》极大地提高了患者的安全性、舒适度和接受度。然而，镇静过程中镇静剂和阿片类药物的使用可能使患者有发生低氧血症的风险。然而，关于程序性镇静期间低氧血症的数据很少。在这里，我们研究了我院镇静程序中低氧血症的发生率和严重程度。
这是一项在荷兰乌得勒支大学医学中心（UMCU）进行的历史性、单中心队列研究。从我们的麻醉信息管理系统中提取了 2011 年 1 月 1 日至 2018 年 12 月 31 日期间我院镇静程序的数据（男性 3459 例，女性 2534 例；总计 5993 例）。低氧血症定义为外周血氧饱和度<90%，持续至少连续 2 分钟。低氧血症的严重程度通过曲线下面积计算。研究了低氧血症严重程度与体重指数（BMI）、美国麻醉医师协会（ASA）身体状况分类和手术持续时间的关系。主要结局是低氧血症的发生率。
29%的中度至深度镇静患者发生低氧血症。在进行心导管室手术（54%）和支气管镜检查的患者（56%）中发现了高发生率的低氧血症。低氧血症主要发生在持续时间较长的手术（>120 分钟），尤其是在手术后期。低氧血症的严重程度与 BMI 或 ASA 身体状况无相关性。
本研究表明，在接受程序性镇静的患者中，相当一部分患者存在发生低氧血症的风险，且与医疗程序持续时间的延长呈正相关。需要进一步的前瞻性研究来调查这种累积性低氧血症的临床后果。
