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Predictor of respiratory disturbances during gastric endoscopic submucosal dissection under deep sedation
BACKGROUND: Sedation is commonly performed for the endoscopic submucosal dissection (ESD) of early gastric cancer. Severe hypoxemia occasionally occurs due to the respiratory depression during sedation. AIM: To establish predictive models for respiratory depression during sedation for ESD. METHODS:...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579530/ https://www.ncbi.nlm.nih.gov/pubmed/33133374 http://dx.doi.org/10.4253/wjge.v12.i10.378 |
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author | Aikawa, Mizuho Uesato, Masaya Urahama, Ryuma Hayano, Koichi Kunii, Reiko Kawasaki, Yohei Isono, Shiroh Matsubara, Hisahiro |
author_facet | Aikawa, Mizuho Uesato, Masaya Urahama, Ryuma Hayano, Koichi Kunii, Reiko Kawasaki, Yohei Isono, Shiroh Matsubara, Hisahiro |
author_sort | Aikawa, Mizuho |
collection | PubMed |
description | BACKGROUND: Sedation is commonly performed for the endoscopic submucosal dissection (ESD) of early gastric cancer. Severe hypoxemia occasionally occurs due to the respiratory depression during sedation. AIM: To establish predictive models for respiratory depression during sedation for ESD. METHODS: Thirty-five adult patients undergoing sedation using propofol and pentazocine for gastric ESDs participated in this prospective observational study. Preoperatively, a portable sleep monitor and STOP questionnaires, which are the established screening tools for sleep apnea syndrome, were utilized. Respiration during sedation was assessed by a standard polysomnography technique including the pulse oximeter, nasal pressure sensor, nasal thermistor sensor, and chest and abdominal respiratory motion sensors. The apnea-hypopnea index (AHI) was obtained using a preoperative portable sleep monitor and polysomnography during ESD. A predictive model for the AHI during sedation was developed using either the preoperative AHI or STOP questionnaire score. RESULTS: All ESDs were completed successfully and without complications. Seventeen patients (49%) had a preoperative AHI greater than 5/h. The intraoperative AHI was significantly greater than the preoperative AHI (12.8 ± 7.6 events/h vs 9.35 ± 11.0 events/h, P = 0.049). Among the potential predictive variables, age, body mass index, STOP questionnaire score, and preoperative AHI were significantly correlated with AHI during sedation. Multiple linear regression analysis determined either STOP questionnaire score or preoperative AHI as independent predictors for intraoperative AHI ≥ 30/h (area under the curve [AUC]: 0.707 and 0.833, respectively) and AHI between 15 and 30/h (AUC: 0.761 and 0.778, respectively). CONCLUSION: The cost-effective STOP questionnaire shows performance for predicting abnormal breathing during sedation for ESD that was equivalent to that of preoperative portable sleep monitoring. |
format | Online Article Text |
id | pubmed-7579530 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-75795302020-10-29 Predictor of respiratory disturbances during gastric endoscopic submucosal dissection under deep sedation Aikawa, Mizuho Uesato, Masaya Urahama, Ryuma Hayano, Koichi Kunii, Reiko Kawasaki, Yohei Isono, Shiroh Matsubara, Hisahiro World J Gastrointest Endosc Observational Study BACKGROUND: Sedation is commonly performed for the endoscopic submucosal dissection (ESD) of early gastric cancer. Severe hypoxemia occasionally occurs due to the respiratory depression during sedation. AIM: To establish predictive models for respiratory depression during sedation for ESD. METHODS: Thirty-five adult patients undergoing sedation using propofol and pentazocine for gastric ESDs participated in this prospective observational study. Preoperatively, a portable sleep monitor and STOP questionnaires, which are the established screening tools for sleep apnea syndrome, were utilized. Respiration during sedation was assessed by a standard polysomnography technique including the pulse oximeter, nasal pressure sensor, nasal thermistor sensor, and chest and abdominal respiratory motion sensors. The apnea-hypopnea index (AHI) was obtained using a preoperative portable sleep monitor and polysomnography during ESD. A predictive model for the AHI during sedation was developed using either the preoperative AHI or STOP questionnaire score. RESULTS: All ESDs were completed successfully and without complications. Seventeen patients (49%) had a preoperative AHI greater than 5/h. The intraoperative AHI was significantly greater than the preoperative AHI (12.8 ± 7.6 events/h vs 9.35 ± 11.0 events/h, P = 0.049). Among the potential predictive variables, age, body mass index, STOP questionnaire score, and preoperative AHI were significantly correlated with AHI during sedation. Multiple linear regression analysis determined either STOP questionnaire score or preoperative AHI as independent predictors for intraoperative AHI ≥ 30/h (area under the curve [AUC]: 0.707 and 0.833, respectively) and AHI between 15 and 30/h (AUC: 0.761 and 0.778, respectively). CONCLUSION: The cost-effective STOP questionnaire shows performance for predicting abnormal breathing during sedation for ESD that was equivalent to that of preoperative portable sleep monitoring. Baishideng Publishing Group Inc 2020-10-16 2020-10-16 /pmc/articles/PMC7579530/ /pubmed/33133374 http://dx.doi.org/10.4253/wjge.v12.i10.378 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Observational Study Aikawa, Mizuho Uesato, Masaya Urahama, Ryuma Hayano, Koichi Kunii, Reiko Kawasaki, Yohei Isono, Shiroh Matsubara, Hisahiro Predictor of respiratory disturbances during gastric endoscopic submucosal dissection under deep sedation |
title | Predictor of respiratory disturbances during gastric endoscopic submucosal dissection under deep sedation |
title_full | Predictor of respiratory disturbances during gastric endoscopic submucosal dissection under deep sedation |
title_fullStr | Predictor of respiratory disturbances during gastric endoscopic submucosal dissection under deep sedation |
title_full_unstemmed | Predictor of respiratory disturbances during gastric endoscopic submucosal dissection under deep sedation |
title_short | Predictor of respiratory disturbances during gastric endoscopic submucosal dissection under deep sedation |
title_sort | predictor of respiratory disturbances during gastric endoscopic submucosal dissection under deep sedation |
topic | Observational Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579530/ https://www.ncbi.nlm.nih.gov/pubmed/33133374 http://dx.doi.org/10.4253/wjge.v12.i10.378 |
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