Risk Factors for Hypoxemia During Ambulatory Gastrointestinal Endoscopy in ASA I–II Patients

  • Mohammed A. Qadeer
  • A. Rocio Lopez
  • John A. Dumot
  • John J. Vargo
Original Article

Abstract

Background Most studies identify the American Society of Anesthesiology (ASA) classification as the most significant risk factor for hypoxemia. The risk factors operative within ASA I and II patients are not well defined. Therefore, we analyzed prospectively collected data to identify the risk factors of hypoxemia in such patients. Methods A combination of a narcotic and benzodiazepine was used for sedation and oxygen was supplemented if hypoxemia (oxygen saturation ≤90%) developed. Univariate and multivariate analyses were performed and correlations estimated for predetermined clinical variables. Results 40 of 79 patients (51%) developed hypoxemia, which occurred more frequently in the obese (71%; 10/14) than the nonobese (46%; 30/65) group (P = 0.08). On multivariate analysis, the odds ratios (OR) and 95% confidence intervals (CI) for developing hypoxemia were age ≥ 60 years 4.5 (1.4–14.3) P = 0.01, and incremental 25-mg doses of meperidine 2.6 (1.02–6.6) P = 0.04. Body mass index (BMI) significantly correlated with the number of hypoxemic episodes (rho 0.26, 95% CI 0.04–0.48, P = 0.02). Conclusion In ASA I and II patients, BMI significantly correlated with the number of hypoxemic episodes, whereas age ≥ 60 years and meperidine dose were significant risk factors for hypoxemia.

Keywords

Hypoxemia Ambulatory endoscopy ASA I and II Body mass index 

References

  1. 1.
    ASGE Standards of Practice Committee. Sedation and monitoring of patients undergoing gastrointestinal endoscopic procedures. Gastrointest Endosc. 1995;42:626–629. doi:10.1016/S0016-5107(95)70031-5.CrossRefGoogle Scholar
  2. 2.
    American Society for Gastrointestinal Endoscopy. Guidelines for conscious sedation and monitoring during gastrointestinal endoscopy. Gastrointest Endosc. 2003;58:317–322. doi:10.1067/S0016-5107(03)00001-4.CrossRefGoogle Scholar
  3. 3.
    American Society of Anesthesiologists Task Force. Practice guidelines for sedation and analgesia by non-anesthesiologists. An updated report by the American society of anesthesiologists task force on sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96:1004–1017. doi:10.1097/00000542-200204000-00031.CrossRefGoogle Scholar
  4. 4.
    Vargo JJ, Holub JL, Faigel DO, Lieberman DA, Eisen GM. Risk factors for cardiopulmonary events during propofol-mediated upper endoscopy and colonoscopy. Aliment Pharmacol Ther. 2006;24:955–963. doi:10.1111/j.1365-2036.2006.03099.x.PubMedCrossRefGoogle Scholar
  5. 5.
    Sharma VK, Nguyen CC, Crowell MD, Lieberman DA, de Garmo P, Fleischer DE. A national study of cardiopulmonary unplanned events after GI endoscopy. Gastrointest Endosc. 2007;66:27–34. doi:10.1016/j.gie.2006.12.040.PubMedCrossRefGoogle Scholar
  6. 6.
    Iber FL, Sutberry M, Gupta R, Kruss D. Evaluation of complications during and after conscious sedation for endoscopy using pulse oximetry. Gastrointest Endosc. 1993;39:620–625.PubMedGoogle Scholar
  7. 7.
    Fisher L, Fisher A, Thomson A. Cardiopulmonary complications of ERCP in older patients. Gastrointest Endosc. 2006;63:948–955. doi:10.1016/j.gie.2005.09.020.PubMedCrossRefGoogle Scholar
  8. 8.
    Woods SD, Chung SC, Leung JW, Chan AC, Li AK. Hypoxia and tachycardia during endoscopic retrograde cholangiopancreatography: detection by pulse oximetry. Gastrointest Endosc. 1989;35:523–525.PubMedCrossRefGoogle Scholar
  9. 9.
    Wong PYN, Lane MR, Hamilton I. Arterial oxygen desaturation during endoscopic retrograde cholangiopancreatography. Endoscopy. 1993;25:309–310.PubMedCrossRefGoogle Scholar
  10. 10.
    Holm C, Christensen M, Rasmussen V, Schulze S, Rosenberg J. Hypoxaemia and myocardial ischaemia during colonoscopy. Scand J Gastroenterol. 1998;33:769–772. doi:10.1080/00365529850171747.PubMedCrossRefGoogle Scholar
  11. 11.
    Johnston SD, McKenna A, Tham TC. Silent myocardial ischaemia during endoscopic retrograde cholangiopancreatography. Endoscopy. 2003;35:1039–1042. doi:10.1055/s-2003-44597.PubMedCrossRefGoogle Scholar
  12. 12.
    Block R, Jankowski J, Johnston D, Colvin JR, Wormsley KG. The administration of supplementary oxygen to prevent hypoxia during upper alimentary endoscopy. Endoscopy. 1993;25:269–273.PubMedCrossRefGoogle Scholar
  13. 13.
    Dhariwal A, Plevris JN, Lo NT, Finlayson ND, Heading RC, Hayes PC. Age, anemia, and obesity-associated oxygen desaturation during upper gastrointestinal endoscopy. Gastrointest Endosc. 1992;38:684–688.PubMedCrossRefGoogle Scholar
  14. 14.
    Vargo JJ, Zuccaro G, Dumot JA, et al. Gastroenterologist-administered propofol versus meperidine and midazolam for advanced upper endoscopy: A prospective, randomized trial. Gastroenterology. 2002;123:8–16. doi:10.1053/gast.2002.34232.PubMedCrossRefGoogle Scholar
  15. 15.
    Iwao T, Toyonaga A, Harada H, et al. Arterial oxygen desaturation during non-sedated diagnostic upper gastrointestinal endoscopy in patients with cirrhosis. Gastrointest Endosc. 1994;40:281–284.PubMedGoogle Scholar
  16. 16.
    Schenck J, Müller CH, Lübbers H, Mahlke R, Lehnick D, Lankisch PG. Does gastroscopy induce myocardial ischemia in patients with coronary heart disease? Endoscopy. 2000;32:373–376. doi:10.1055/s-2000-9005.PubMedCrossRefGoogle Scholar
  17. 17.
    Seinelä L, Reinikainen P, Ahvenainen J. Effect of upper gastrointestinal endoscopy on cardiopulmonary changes in very old patients. Arch Gerontol Geriatr. 2003;37:25–32. doi:10.1016/S0167-4943(03)00002-5.PubMedCrossRefGoogle Scholar
  18. 18.
    Haines DJ, Bibbey J, Green JR. Does nasal oxygen reduce the cardiorespiratory problems experienced by elderly patients undergoing endoscopic retrograde cholangiopancreatography? Gut. 1992;33:973–975. doi:10.1136/gut.33.7.973.PubMedCrossRefGoogle Scholar
  19. 19.
    Griffin MS, Chung SCS, Leung JWC, et al. Effects of oxygen and hypoxemia and tachycardia during endoscopic retrograde cholangiopancreatography. BMJ. 1990;300:83–84.PubMedCrossRefGoogle Scholar
  20. 20.
    Rimmer KP, Graham K, Whitelaw WA, Field SK. Mechanisms of hypoxemia during panendoscopy. J Clin Gastroenterol. 1989;11:17–22. doi:10.1097/00004836-198902000-00006.PubMedCrossRefGoogle Scholar
  21. 21.
    Vargo JJ, Zuccaro G, Dumot JA, Conwell DL, Morrow JB, Shay SS. Automated assessment of respiratory activity is superior to pulse oximetry and visual assessment for the detection of early respiratory depression during therapeutic upper endoscopy. Gastrointest Endosc. 2002;55:826–831. doi:10.1067/mge.2002.124208.PubMedCrossRefGoogle Scholar
  22. 22.
    Müller S, Prolla JC, Maguilnik I, Breyer HP. Predictive factors of oxygen desaturation of patients submitted to endoscopic retrograde cholangiopancreatography under conscious sedation. Arq Gastroenterol. 2004;4:162–166.Google Scholar
  23. 23.
    Gangi S, Saidi F, Patel K, et al. Cardiovascular complications after GI endoscopy: occurrence and risks in a large hospital system. Gastrointest Endosc. 2004;60:679–685. doi:10.1016/S0016-5107(04)02016-4.PubMedCrossRefGoogle Scholar
  24. 24.
    Qadeer MA, Vargo JJ, Patel S, et al. Utility of bispectral index monitoring of conscious sedation with the combination of meperidine and midazolam during gastrointestinal endoscopy. Clin Gastroenterol Hepatol. 2008;6:102–108. doi:10.1016/j.cgh.2007.10.005.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Mohammed A. Qadeer
    • 1
  • A. Rocio Lopez
    • 2
  • John A. Dumot
    • 1
  • John J. Vargo
    • 1
  1. 1.Department of Gastroenterology and Hepatology, Digestive Disease InstituteCleveland Clinic FoundationClevelandUSA
  2. 2.Quantitative Health SciencesCleveland ClinicClevelandUSA

Personalised recommendations