Decreasing the Incidence of Hypoxia and Airway Maneuvers During GI Procedures.

Many outpatient gastrointestinal procedures are completed with propofol anesthesia. A side effect of propofol is airway obstruction and subsequent hypoxia. This study was designed to determine whether the use of a high-flow nasal cannula is associated with a decreased incidence of hypoxia or airway obstruction in patients undergoing propofol sedation in the gastrointestinal laboratory with a STOP-BANG score ≥5. High-flow nasal cannula was administered at 70 L/min on 27 patients with a STOP-BANG score ≥5 receiving monitored anesthesia care sedation for an esophagogastroduodenoscopy, endoscopic ultrasound, or colonoscopy procedure. Patients were compared to a group from a previous project without the use of high-flow nasal cannula assessing whether hypoxia, apnea, or the need for airway maneuvers occurred. The non-high-flow nasal cannula group required an airway maneuver 53.3% (n = 8) whereas the high-flow nasal cannula group required an airway maneuver 18.5% (n = 5) (p = .021). High-flow nasal cannula was associated with a reduced need for airway maneuvers in patients with a high risk of obstructive sleep apnea undergoing propofol-assisted procedures.

STOP-BANG as a Pre-procedure Risk Assessment Tool to Predict Intraprocedure Airway Maneuvers and Adverse Events in a Gastrointestinal Laboratory.

A high prevalence of undiagnosed obstructive sleep apnea (OSA) exists in patients receiving sedation for gastrointestinal laboratory (GI lab) procedures, with potentially serious adverse events associated with untreated OSA. This quality improvement project aimed to identify patients at high risk of OSA and evaluate their risk of intraprocedure airway maneuvers and adverse events in a GI lab. In the GI lab, nurses administered and documented the STOP-BANG questionnaire as part of their pre-procedure assessment of 80 patients presenting for elective procedures. The occurrence of airway maneuvers and adverse events during the procedures was measured using a checklist given to nurse anesthetists as they brought patients to the postprocedure area. Patients with STOP-BANG scores below 5 and with scores of 5 and above were compared. Descriptive and inferential statistics were used to analyze differences in patient outcomes. Patients with high STOP-BANG scores had an increased need for airway maneuvers and higher occurrence of adverse events (P=.05). These results support the use of STOP-BANG as a pre-procedure risk assessment tool. Anesthesia professionals can anticipate intraprocedure airway interventions, consider preemptive interventions in a GI lab, and be more vigilant when caring for patients with high STOP-BANG scores at high risk of undiagnosed OSA.