Tyler McVay1, John C Fang2, Linda Taylor1, Alexander Au1, Wesley Williams1, Angela P Presson3, Ragheed Al-Dulaimi3, Eric Volckmann4, Anna Ibele4. 1. Division of Gastroenterology, Hepatology and Nutrition, University of Utah School of Medicine, 30 N 1900 E SOM 4R118, Salt Lake City, UT, 84132, USA. 2. Division of Gastroenterology, Hepatology and Nutrition, University of Utah School of Medicine, 30 N 1900 E SOM 4R118, Salt Lake City, UT, 84132, USA. John.Fang@hsc.utah.edu. 3. Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA. 4. Division of General Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
Abstract
BACKGROUND: Non-anesthesia administered propofol (NAAP) has been shown to be a safe and effective method of sedation for patients undergoing gastrointestinal endoscopy. Bariatric surgery patients are potentially at a higher risk for sedation-related complications due to co-morbidities including obstructive sleep apnea. The outcomes of NAAP in bariatric patients have not been previously reported. METHODS: In this retrospective cohort study, severely obese patients undergoing pre-surgical outpatient esophagogastroduodenoscopy (EGD) were compared to non-obese control patients (BMI ≤ 25 kg/m2) undergoing diagnostic EGD at our institution from March 2011-September 2015 using our endoscopy database. Patients' demographics and procedural and recovery data, including any airway interventions, were statistically analyzed. RESULTS: We included 130 consecutive pre-operative bariatric surgical patients with average BMI 45.8 kg/m2 (range 34-80) and 265 control patients with average BMI 21.9 kg/m2 (range 14-25). The severely obese group had a higher prevalence of sleep apnea (62 vs 8%; p < 0.001), experienced more oxygen desaturations (22 vs 7%; p < 0.001), and received more chin lift maneuvers (20 vs 6%; p < 0.001). Advanced airway interventions were rarely required in either group and were not more frequent in the bariatric group. CONCLUSIONS: With appropriate training of endoscopy personnel, NAAP is a safe method of sedation in severely obese patients undergoing outpatient upper endoscopy.
BACKGROUND: Non-anesthesia administered propofol (NAAP) has been shown to be a safe and effective method of sedation for patients undergoing gastrointestinal endoscopy. Bariatric surgery patients are potentially at a higher risk for sedation-related complications due to co-morbidities including obstructive sleep apnea. The outcomes of NAAP in bariatric patients have not been previously reported. METHODS: In this retrospective cohort study, severely obesepatients undergoing pre-surgical outpatient esophagogastroduodenoscopy (EGD) were compared to non-obese control patients (BMI ≤ 25 kg/m2) undergoing diagnostic EGD at our institution from March 2011-September 2015 using our endoscopy database. Patients' demographics and procedural and recovery data, including any airway interventions, were statistically analyzed. RESULTS: We included 130 consecutive pre-operative bariatric surgical patients with average BMI 45.8 kg/m2 (range 34-80) and 265 control patients with average BMI 21.9 kg/m2 (range 14-25). The severely obese group had a higher prevalence of sleep apnea (62 vs 8%; p < 0.001), experienced more oxygen desaturations (22 vs 7%; p < 0.001), and received more chin lift maneuvers (20 vs 6%; p < 0.001). Advanced airway interventions were rarely required in either group and were not more frequent in the bariatric group. CONCLUSIONS: With appropriate training of endoscopy personnel, NAAP is a safe method of sedation in severely obesepatients undergoing outpatient upper endoscopy.
Authors: Sachin Wani; Riad Azar; Christine E Hovis; Robert M Hovis; Gregory A Cote; Matthew Hall; Lawrence Waldbaum; Vladimir Kushnir; Dayna Early; Daniel K Mullady; Faris Murad; Steven A Edmundowicz; Sreenivasa S Jonnalagadda Journal: Gastrointest Endosc Date: 2011-12 Impact factor: 9.427
Authors: Anita P Courcoulas; Susan Z Yanovski; Denise Bonds; Thomas L Eggerman; Mary Horlick; Myrlene A Staten; David E Arterburn Journal: JAMA Surg Date: 2014-12 Impact factor: 14.766
Authors: Andreas Sieg; Sebastian Beck; Sabine G Scholl; Franz J Heil; Daniel N Gotthardt; Wolfgang Stremmel; Douglas K Rex; Kilian Friedrich Journal: J Gastroenterol Hepatol Date: 2014-03 Impact factor: 4.029
Authors: Gregory A Coté; Robert M Hovis; Michael A Ansstas; Lawrence Waldbaum; Riad R Azar; Dayna S Early; Steven A Edmundowicz; Daniel K Mullady; Sreenivasa S Jonnalagadda Journal: Clin Gastroenterol Hepatol Date: 2009-07-14 Impact factor: 11.382
Authors: Stavros G Memtsoudis; Crispiana Cozowicz; Mahesh Nagappa; Jean Wong; Girish P Joshi; David T Wong; Anthony G Doufas; Meltem Yilmaz; Mark H Stein; Megan L Krajewski; Mandeep Singh; Lukas Pichler; Satya Krishna Ramachandran; Frances Chung Journal: Anesth Analg Date: 2018-10 Impact factor: 5.108