Identification of Patient-Related and Procedure-Related Factors Contributing to Hypoxemia in Adult Outpatients Undergoing Esophagogastroduodenoscopy (EGD).

PURPOSE: To assess which patient factors and procedure-related factors contribute to hypoxemia during esophagogastroduodenoscopy (EGD) and determine whether prophylactic oropharyngeal suctioning reduces the rate of hypoxemia when compared to oropharyngeal suctioning when clinically indicated by patient's coughing or secretions. DESIGN: This was a single-site study taking place at a private practice, outpatient facility with no anesthesia trainees present. Patients were randomized to one of two groups based on birth month. After the administration of sedating medications but before the insertion of the endoscope, Group A was oropharyngeal suctioned by either the anesthesia provider or the proceduralist. Group B was oropharyngeal suctioned only when clinically indicated by coughing or visible copious secretions. METHODS: Data were collected on a variety of patient and procedure-related factors. Associations between these factors and hypoxemia during esophagogastroduodenoscopy were analyzed using the statistical analysis system application JMP. After analysis and literature review, a protocol for prevention and treatment of hypoxemia during EGD was proposed. FINDINGS: This study found that chronic obstructive pulmonary disease increases the risk for hypoxemia during esophagogastroduodenoscopy. There were no other statistically significant associations between other factors and hypoxemia. CONCLUSIONS: This study highlights factors that should be evaluated in the future when considering the risk of hypoxemia during EGD. Although not statistically significant, this study's results indicated that prophylactic oropharyngeal suctioning may reduce rates of hypoxemia, as only 1 of 4 cases of hypoxemia occurred in Group A. Additionally, future studies on hypoxemia during monitored anesthesia care for EGD should include an evaluation of the impact of American Society of Anesthesiologists class, history of chronic obstructive pulmonary disease or asthma, body mass index, obstructive sleep apnea, and opioid administration on hypoxemia risk.

Simulation for Student Registered Nurse Anesthetists: Common Pediatric Anesthesia Complications.

Student registered nurse anesthetists (SRNAs) are required by the Council on Accreditation to provide anesthetics to a minimum of 30 patients ages 2-12 years and 10 patients younger than 2 years. Pediatric anesthesia can prove to be stressful because children are at higher risk for morbidity and mortality during the perioperative period compared with adults. Simulation allows SRNAs the opportunity to review and develop skills in a safe and supportive environment. The purpose of this project was to provide a high-fidelity pediatric simulation for SRNAs prior to their pediatric rotation to improve skills, knowledge, and self-confidence in the recognition and management/treatment of common pediatric anesthesia complications (airway obstruction, laryngospasm, bronchospasm, and bradycardia). Twenty SRNAs enrolled in a nurse anesthesia program participated in the pediatric anesthesia simulation prior to the start of their pediatric anesthesia rotation. Participants completed surveys at three intervals; presimulation, postsimulation, and at the end of their pediatric rotation that addressed the trainee's perceived self-confidence level and ability to identify and manage/treat common pediatric anesthesia complications. Statistical significance (P < .05) was achieved in the participants overall self-confidence levels in their ability to recognize, treat, and manage common pediatric complications (P = .00) after completion of simulation experience.