Polysomnographic assessment of respiratory disturbance during deep propofol sedation for endoscopic submucosal dissection of gastric tumors  

作　　者：Ryuma Urahama Masaya Uesato Mizuho Aikawa Yukiko Yamaguchi Koichi Hayano Tomoaki Matsumura Makoto Arai Reiko Kunii Shiroh Isono Hisahiro Matsubara 

机构地区：[1]Department of Frontier Surgery, Chiba University Graduate School of Medicine [2]Department of Gastroenterology, Chiba University Graduate School of Medicine [3]Department of Medical Oncology, Chiba University Graduate School of Medicine [4]Staff of Clinical Laboratory, Chiba University Hospital [5]Department of Anesthesiology, Chiba University Graduate School of Medicine

出　　处：《World Journal of Gastrointestinal Endoscopy》2018年第11期340-347,共8页世界胃肠内镜杂志（英文版）（电子版）

基　　金：Supported by a grant received from Japan Society for the Promotion of Science,NO.15K09056

摘　　要：AIM To investigate that polysomnographic monitoring can accurately evaluate respiratory disturbance incidence during sedation for gastrointestinal endoscopy compare to pulse oximetry alone.METHODS This prospective observational study included 10 elderly patients with early gastric cancer undergoing endoscopic submucosal dissection(ESD) under propofol sedation. Apart from routine cardiorespiratory monitoring, polysomnography measurements were acquired. The primary hypothesis was tested by comparing the apnea hypopnea index(AHI), defined as the number of apnea and hypopnea instances per hour during sedation, with and without hypoxemia; hypoxemia was defined as the reduction in oxygen saturation by ≥ 3% from baseline.RESULTS Polysomnography(PSG) detected 207 respiratory disturbances in the 10 patients. PSG yielded a significantly greater AHI(10.44 ± 5.68/h) compared with pulse oximetry(1.54 ± 1.81/h, P < 0.001), thus supporting our hypothesis. Obstructive AHI(9.26 ± 5.44/h) was significantly greater than central AHI(1.19 ± 0.90/h, P < 0.001). Compared with pulse oximetry, PSG detected the 25 instances of respiratory disturbances with hypoxemia 107.4 s earlier on average.CONCLUSION Compared with pulse oximetry, PSG can better detect respiratory irregularities and thus provide superior AHI values, leading to avoidance of fatal respiratory complications during ESD under propofol-induced sedation.AIM To investigate that polysomnographic monitoring can accurately evaluate respiratory disturbance incidence during sedation for gastrointestinal endoscopy compare to pulse oximetry alone.METHODS This prospective observational study included 10 elderly patients with early gastric cancer undergoing endoscopic submucosal dissection(ESD) under propofol sedation. Apart from routine cardiorespiratory monitoring, polysomnography measurements were acquired. The primary hypothesis was tested by comparing the apnea hypopnea index(AHI), defined as the number of apnea and hypopnea instances per hour during sedation, with and without hypoxemia; hypoxemia was defined as the reduction in oxygen saturation by ≥ 3% from baseline.RESULTS Polysomnography(PSG) detected 207 respiratory disturbances in the 10 patients. PSG yielded a significantly greater AHI(10.44 ± 5.68/h) compared with pulse oximetry(1.54 ± 1.81/h, P < 0.001), thus supporting our hypothesis. Obstructive AHI(9.26 ± 5.44/h) was significantly greater than central AHI(1.19 ± 0.90/h, P < 0.001). Compared with pulse oximetry, PSG detected the 25 instances of respiratory disturbances with hypoxemia 107.4 s earlier on average.CONCLUSION Compared with pulse oximetry, PSG can better detect respiratory irregularities and thus provide superior AHI values, leading to avoidance of fatal respiratory complications during ESD under propofol-induced sedation.

关 键 词：POLYSOMNOGRAPHY HYPOXEMIA PROPOFOL Endoscopic SUBMUCOSAL dissection Pulse OXIMETRY SEDATION 

分 类 号：R[医药卫生]