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October 18, 2008
10:00 AM - 11:30 AM
Room Room 230D
Arterial Desaturation and Airway Intervention during Deep Propofol Sedation for Outpatient Endoscopy
Daniel R. Bustamante, M.D., Jonathan S. DiRuzzo, M.D., Roger C. Carroll, Ph.D., Carolyn G. Snider, M.T., Patrick A. Dakin, B.S.
Department of Anesthesiology, University of Tennessee Medical Center, Knoxville, Tennessee
Background: Propofol administration to produce deep sedation or general anesthesia has become the standard for outpatient endoscopy at our institution and the technique is well accepted by our gastroenterologists and patients. This technique is commonly used at other centers. The purpose of this study was to determine the incidence of significant arterial desaturation (SaO2 < 90%) during outpatient endoscopy utilizing propofol for deep sedation or general anesthesia and to determine the frequency with which airway interventions occurred during these procedures. Methods: After IRB approval and informed consent, 200 patients (ASA Class 1-3, age 18 or greater) scheduled for outpatient colonoscopy, esophagogastroduodenoscopy (EGD) or both were enrolled. Age, self-reported height, self-reported weight, and ASA class were obtained for each patient. Each patient was specifically asked whether he or she had a history of sleep apnea. Propofol was administered to provide deep sedation or general anesthesia. To minimize the discomfort of propofol injection, lidocaine was the only other medication administered. Anesthesia providers administered propofol as necessary to facilitate the successful completion of the procedures. ECG, non-invasive blood pressure and continuous pulse oximetry were monitored utilizing a GE Dash 4000. Each patient also received nasal cannula oxygen and nasal capnography was monitored. If the SaO2 was less than 90% at any time during the procedure, this occurrence was noted by the anesthesia provider. Additionally the monitor was programmed to automatically print a record if the oxygen saturation decreased to less than 90%. Any airway maneuver utilized during the procedure (jaw thrust/chin lift, oral airway, nasal airway, bag-mask ventilation, LMA insertion or intubation) was recorded by the anesthesia provider. Results: Arterial desaturation (<90%) occurred in 17.5% of all subjects. Airway maneuvers were utilized in 28.5% of patients. 63 airway maneuvers were utilized in 57 patients (57 jaw thrust/chin lift, 3 nasal airways, 1 oral airway, 1 LMA, 1 bag-mask ventilation). Arterial desaturation significantly correlated with obesity, BMI≥30, (P=0.0006, Chi-square), with a history of sleep apnea (P<0.0001) and with increasing ASA class (P=0.016). Utilization of airway maneuvers significantly correlated with obesity (P<0.0001), sleep apnea (P<0.0001), and increasing ASA classification (P=0.0003). Discussion: This observational study demonstrated that arterial desaturation is a frequent occurrence during deep propofol sedation or general anesthesia for outpatient endoscopic procedures. Airway maneuvers were frequently utilized during the performance of these procedures. The most commonly utilized airway maneuver was a simple chin lift or jaw thrust, but a smaller number of patients (3%) required a greater degree of airway assistance. Obesity, sleep apnea and increasing ASA class correlated with both the frequency of arterial desaturation and with the utilization of airway maneuvers. Given the frequent occurrence of oxygen desaturation and the common utilization of airway maneuvers during deep propofol sedation or general anesthesia for outpatient endoscopic procedures, the presence of personnel trained in airway management and the availability of airway management equipment would seem to be important patient safety considerations.

Anesthesiology 2008; 109 A193