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Predicting Need for Airway Intervention During Endoscopy

Summary and Comment |
December 12, 2013

Predicting Need for Airway Intervention During Endoscopy

  1. Douglas K. Rex, MD

Use of the STOP-BANG questionnaire did not help to identify patients more likely to need an airway intervention or to have a sedation-related adverse event.

  1. Douglas K. Rex, MD

Obstructive sleep apnea (OSA) is widely assumed to increase the need for airway interventions during endoscopic procedures. The STOP-BANG questionnaire is a validated predictor of OSA that has been shown to predict airway events during advanced endoscopic procedures, including endoscopic retrograde cholangiopancreatography and endoscopic ultrasound. Can it predict such events during routine colonoscopy and esophagogastroduodenoscopy (EGD)?

To answer this question, investigators examined the risks for airway intervention (AIs) and sedation-related adverse events (SRAEs) in a prospective cohort of 243 patients undergoing routine colonoscopy or EGD. AIs included chin lift maneuver, nasopharyngeal airway placement, bag-mask ventilation, and unplanned endotracheal intubation. SRAEs included systolic blood pressure <90 mm Hg, a decrease in systolic blood pressure of >25% from baseline, oximetry <90% at any time, and a respiratory rate <6 breaths per minute based on capnography. Patients were considered to be at increased risk for undiagnosed OSA if they had a score of ≥3 on the STOP-BANG survey.

Increased risk for OSA was not associated with occurrence of AIs or SRAEs. An increase in body mass index of 1 kg/m2 was associated with increased risks for both AIs (relative risk, 1.02) and SRAEs (RR, 1.03). Independent risk factors for SRAEs were increased patient age (RR, 1.09 per 5-year increase), higher loading doses of propofol (RR, 1.4 per 1-mg dose increase), and past or current smoking (RR, 1.9).

Comment

Patient weight was a stronger independent risk factor than predicted high likelihood of sleep apnea for airway interventions and sedation-related adverse events. Of other identified factors, the most easily controlled by practitioners is the propofol loading dose. Study drawbacks were the small number of patients in the study and the lack of clinical significance of some of the sedation-related adverse events. Of note, no life-threatening events were reported in this study.

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant / Advisory board Exact Sciences; Ferring Pharmaceuticals; Given Imaging; Olympus Speaker’s bureau Boston Scientific; Braintree; Ferring Pharmaceuticals Grant / research support Battelle; Braintree; Northwestern University; Olympus America Editorial boards Annals of Gastroenterology and Hepatology; Comparative Effectiveness Research; Expert Review of Gastroenterology and Hepatology; Gastroenterology; Gastroenterology and Hepatology News; Gastroenterology Report; Gastroenterology Research and Practice; Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; World Journal of Gastroenterology; World Journal of Gastrointestinal Oncology; World Journal of Gastrointestinal Pathophysiology; World Journal of Gastrointestinal Pharmacology and Therapeutics

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