Safety of Gastrointestinal Endoscopy with Monitored Anesthesia Care in Patients with Obstructive Sleep Apnea

Abstract

Introduction: Patients with obstructive sleep apnea (OSA) undergoing endoscopy with sedation are considered by practitioners to be at a higher risk for cardiopulmonary complications. The aim of the present study was to evaluate the safety of monitored anesthesia care (MAC) in patients with OSA undergoing gastrointestinal endoscopy. Methods: We performed a prospective single arm cohort study at the James A. Haley VA Hospital which was IRB-approved. All consecutive adult patients with OSA confirmed using polysomnography undergoing endoscopy with MAC were eligible for inclusion. Cardiopulmonary variables such as heart rate, level of blood oxygen saturation and blood pressure were recorded continuously throughout the endoscopic procedures. Additionally, anesthesia maneuvers such as the use of suction, head tilt, nasal trumpet, and laryngeal mask airway (LMA) were recorded. Other variables such as the use of CPAP, bronchodilators, robinol, and lidocaine either as vein analgesia or for arrhythmia were also recorded. Event rates were assessed using descriptive statistics. All analyses were performed using SPSS v22 statistical analysis software. Results: A total of 76 with confirmed moderate or severe OSA met the inclusion criteria. Heart rate remained stable in 96.1% (n=73/76), blood pressure remained stable in 100% (n=76/76), and O2 saturation remained stable in 96% (n=72/76) of patients. Changes in heart rate and O2 saturation were transitory and recovered spontaneously without any additional intervention. In our cohort suction was only needed in 21.1% (n=16/76), head tilt was performed in 28.9% (n=22/76), nasal trumpet was used in 7.9% (n=6/76), LMA was used in 1.3% (n=1/76), 97.4% (n=74/76) of the patients maintained a normal pCO2 and none required the use of CPAP. IV lidocaine was used in 68.4% (n=52/76) of patients for vein analgesia and none required IV lidocaine for arrhythmia control. Bronchodilators were used in 2.6% (n=2/76) and robinol was used in 14.5% (n=11/76) of patients to inhibit intestinal motility. None of the cases required advanced anesthesia care such as general endotracheal intubation nor was there a procedure aborted. Conclusion: Despite the presumed increased risk of cardiopulmonary complications, patients with OSA who undergo endoscopy with monitored anesthesia care have clinically insignificant variations in cardiopulmonary parameters as suggested by this prospective study. Additionally, the anesthesia-related interventions were clinically insignificant.