Research Article
Sedasyon Uygulanan Gastroskopik Girişimlerde Aneminin Integrated Pulmonary Index (IPI ) Skoruna Etkisi
Abstract
Amaç: Endoskopik prosedürlerde sedasyon uygulamalarında çeşitli komplikasyonlar morbiditenin önde gelen nedenidir ve kılavuzlar dolaşım, solunum fonksiyonu ve ventilasyonun sürekli izlenmesini önerir. Bu izlemede kullanılabilen yöntemler den biri olan Integrated Pulmonary Index (IPI), Oksijen satürasyonu, End-tidal karbondioksit konsantrasyonu, solunum sayısı ve kalp hızı değerlerinin sürekli ve eş zamanlı ortak matematiksel analiziyle elde edilen, tek bir rakamsal değer verir ve bu girişimlerde iyi bir monitorizasyon ve takip sağlar.
Bu çalışmada gastroskopi girişimlerinde sedasyon uygulanan anemik hastalarda IPI’nın solunumsal komplikasyonların tanı ve takibindeki yerini belirlemeyi amaçladık.
Gereç ve Yöntem: Gastroskopi girişimi için sedasyon uygulanan hastalar çalışma için iki gruba ayrıldı. Anemisi bulunan hastalar 1. Grup (n:155 ) olarak, anemisi bulunmayan hastalar 2. Grup (n:158- kontrol grubu ) belirlendi. Hastaların yaş, cinsiyet, BMI, ASA fiziksel durum sınıflaması, yandaş hastalıkları, kullanılan ilaç dozları ile işlem öncesi bazal(0) ve 5. ,10. dakika ortalama arteryal kan basıncı(OAB), kalp hızı, SpO2, solunum sayısı, EtCO2, IPI değerleri tespit edildi. Takip edilen bu parametreler üzerinden solunumsal komplikasyonlar belirlenerek iki grup karşılaştırıldı.
Bulgular: Çalışmaya alınan 313 hastanın % 49’u erkek olup yaş ortalaması 53±16.5 idi. İki grup arasında 0,5 ve 10. dk’lar için IPI skoru, IPI skorunu oluşturan diğer bileşenler ( SpO2, solunum hızı ve EtCO2) ve OAB açısından anlamlı fark yoktu (p>0.05).Ancak 2. Grup hastaların, kalp hızı tüm ölçüm zamanları için 1.gruptan daha yüksek bulundu (p<0.001). Ayrıca iki grup arasında, IPI ve alt monitorizasyon parametreleri üzerinden tanımlanan solunum komplikasyonları açısından anlamlı fark bulunmadı (p>0.05).
Sonuç: Gastroskopik girişimlerde sedasyon uygulamalarında anemi, solunumsal komplikasyonların ortaya çıkması açısından bir risk oluşturmamaktadır. IPI monitorizasyonu, Gastroskopi girişimlerinde sedasyon uygulanan anemik hastalarda, anemisi olmayan diğer hastalar gibi doğru ve güvenli bir monitorizasyonla hastaların takibini sağlamaktadır.
References
- 1. World Health Organization. Nutritional anaemias: Report of a WHO scientific group. Geneva, Switzerland: World Health Organization; 1968.
- 2. World Health Organization. Assessing the Iron Status of Populations, Including Literature Reviews: Report of a Joint World Health Organization/Centers for Disease Control and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level. 2nd Ed. 2004.
- 3. Kassebaum NJ, Jasrasaria R, Naghavi M, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood 2014;123:615–24.
- 4. Pang WW, Schrier SL. Anemia in the elderly. Curr Opin Hematol 2012;19:133–40.
- 5.Stephens MR, Hopper AN, White SR, et al. Colonoscopy first for iron-deficiency anemia: a number needed to investigate approach. Q J Med 2006;99:389–95.
- 6. Pongprasobchai S, Sriprayoon T, Manatsathit S. Prospective Evaluation of Gastrointestinal Lesions by Bidirectional Endoscopy in Patients With Iron Deficiency Anemia. J Med Assoc Thai. 2011 Nov;94(11):1321-6.
- 7. Schlag C, Wörner A, Wagenpfeil S, Kochs EF, Schmid RM, et al. (2013) Capnography improves detection of apnea during procedural sedation for percutaneous transhepatic cholangiodrainage. Can J Gastroenterol 27: 582-586.
- 8.American Society of Anesthesiologists. Practice guidelines for sedation and analgesia by nonanesthesiologists. http://asahq.org/publicationsAndServices/practic eparam.ht
- 9. Dumonceau JM, Riphaus A, Aparicio JR, Beilenhoff U, Knape JT, et al. (2010) European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: Non-anesthesiologist administration of propofol for GI endoscopy. Endoscopy 42: 960-974.
- 10. Galvagno SM, Kodali BS (2009) Critical monitoring issues outside the operating room. Anesthesiology Clin 27: 141-156
- 11. Soto RG, Fu ES, Vila H Jr, Miguel RV. Capnography accurately detects apnea during monitored anesthesia care. Anesth Analg. 2004 Aug;99(2):379-82, table ofcontents. PubMed PMID: 15271710.
- 12. Srinivasa V, Kodali BS. Capnometry in the spontaneously breathing patient. Curr Opin Anaesthesiol. 2004 Dec;17(6):517-20. PubMed PMID: 17031088
- 13. Bhananker SM, Posner KL, Cheney FW, Caplan RA, Lee LA, Domino KB. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology. 2006 Feb;104(2):228-34. PubMed PMID: 16436839.
- 14. Arora S, Singh PM,Goudra BG, Sinha AC. Changing trends of hemodynamic monitoring in ICU–from invasivetonon-invasive methods: Are we there yet? Int J Crit Il ln Inj Sci. 2014; 4:168-77.
- 15. Small heer BA.Technology and monitoring patients at the bedside. Nurs Clin North Am.2015;50: 257-68.
- 16. Dar AQ, Shah ZA. Anesthesia and sedation in pediatric gastrointestinal endoscopic procedures: A review. World J Gastrointest Endosc 2010; 2 (7): 257-262,
- 17. Ronen M, Weissbrod R, Overdyk FJ, Ajizian S. Smart respiratory monitoring: clinical development and validation of the IPI™ (Integrated Pulmonary Index) algorithm. Journal of Clinical Monitoring and Computing. 2016. https://doi.org/10.1007/s10877-016-9851-7
- 18. Behrens A, Kreuzmayr A, Manner H, et al. Acute sedation-associated complications in GI endoscopy (ProSed 2 Study): results from the prospective multicentre electronic registry of sedation-associated complications [published online ahead of print, 2018 Jan 3]. Gut. 2018;gutjnl-2015-311037. doi:10.1136/gutjnl-2015-311037
- 19.Leslie K, Allen ML, Hessian EC, et al. Safety of sedation for gastrointestinal endoscopy in a group of university-affiliated hospitals: a prospective cohort study. Br J Anaesth. 2017;118(1):90‐99. doi:10.1093/bja/aew393
- 20. http://asahq.org
- 21. (2002) Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 96: 1004-1017.
- 22. Pang WW, Schrier SL. Anemia in the elderly. Curr Opin Hematol 2012;19:133–40.
- 23.Stephens MR, Hopper AN, White SR, et al. Colonoscopy first for iron-deficiency anemia: a number needed to investigate approach. Q J Med 2006;99:389–95.
- 24. Serefhanoglu S, Buyukasik Y, Emmungil H, Sayinalp N, Haznedaroglu,IC, Goker H, Aksu S, Ozcebe OI. Identification of Clinical and Simple Laboratory Variables Predicting Responsible Gastrointestinal Lesions in Patients With Iron Deficiency Anemia. Int J Med Sci. 2010 Dec 28;8(1):30-8.doi: 10.7150/ijms.8.30.
- 25.Goudra BG, Singh PM, Penugonda LC, Speck RM, Sinha AC. Significantly reduced hypoxemic events in morbidly obese patients undergoing gastrointestinal endoscopy: Predictors and practice effect. J Anaesthesiol Clin Pharmacol. 2014;30(1):71‐77. doi:10.4103/0970-9185.125707
- 26. 75 Million Endoscopies Performed Annually According to iData Research Procedure Analysis. Available at: https://idataresearch.com/75-million-endoscopies-performed-annually-according-to-idata-research-procedure-analysis/ (Accessed on February 04, 2019)
- 27.Sharma VK, Nguyen CC, Crowell MD, Lieberman DA, de Garmo P, Fleischer DE. A national study of cardiopulmonary unplanned events after GI endoscopy.Gastrointest Endosc. 2007 Jul;66(1):27-34. PubMed PMID: 17591470
- 28. Goudra B, Nuzat A, Singh PM, Borle A, Carlin A, Gouda G. Association between Type of Sedation and the Adverse Events Associated with Gastrointestinal Endoscopy: An Analysis of 5 Years’ Data from a Tertiary Center in the USA. Clin Endosc. 2017;50(2):161-169. doi:10.5946/ce.2016.019.
- 29. Vargo, J. J., Niklewski, P. J., Williams, J. L., Martin, J. F., & Faigel, D. O. Patient safety during sedation by anesthesia professionals during routine upper endoscopy and colonoscopy: an analysis of 1.38 million procedures. Gastrointestinal endoscopy, 2017; 85(1), 101-108. DOI:10.1016/j.gie.2016.02.007
- 30. Leslie, K., Allen, M. L., Hessian, E. C., Peyton, P. J., Kasza, J., Courtney, A., et.alSafety of sedation for gastrointestinal endoscopy in a group of university-affiliated hospitals: a prospective cohort study. BJA: British Journal of Anaesthesia, 2016; 118(1), 90-99. DOI:10.1093/bja/aew393
- 31.Wang CY, Ling LC, Cardosa MS, Wong AK, Wong NW (2000) Hypoxia during upper gastrointestinal endoscopy with and without sedation and the effect of pre-oxygenation on oxygen saturation. Anaesthesia 55: 654-658.
- 32.Reed MW, O'Leary DP, Duncan JL, Majeed AW, Wright B, et al. (1993) Effects of sedation and supplemental oxygen during upper alimentary tract endoscopy. Scand J Gastroenterol 28: 319-322.
- 33. Deitch K, Miner J, Chudnofsky CR, Dominici P, Latta D. Does end tidal CO2 monitoring during emergency department procedural sedation and analgesia with propofol decrease the incidence of hypoxic events? A Randomized, Controlled Trial. Ann Emerg Med 2010; 55: 258-64. DOI:10.1016/j.annemergmed.2009.07.030
- 34.ASA Standards for Basic Anesthetic Monitoring Approved by the ASA House of Delegates on October 21, 1986, and last amended on October 20, 2010 with an effective date of July 1, 2011.
- 35. van Loon K, van Rheineck Leyssius AT, van Zaane B, Denteneer M, Kalkman CJ(2014) Capnography During Deep Sedation with Propofol by Nonanesthesiologists: A Randomized Controlled Trial. Anesth Analg 119: 49-55
- 36. Wadhwa V, Gupta K, Vargo JJ. Monitoring standards in sedation and analgesia: the odyssey of capnography in sedation for gastroenterology procedures. Curr Opin Anaesthesiol. 2019 Aug;32(4):453-456. doi: 10.1097/ACO.0000000000000756. Review. PubMed PMID: 31169549.
- 37. Lightdale R, Fredette M, Atmadja M, Heard L, Jiang H. (2010) M1563:Pilot Study of the Smart Capnography Integrated Pulmonary Index™ in a pediatric gastroenterology procedure unit. Gastrointest Endosc 71:AB255.
- 38. Restrepo RD, Otaibi AA, Wittnebel L, Shammari YA, Ismaeil T (2013) Correlation between ABG parameters and the integrated pulmonary indexbin a medical-surgical ICU in saudi arabia. Anesthesia and Analgesia 117 (4S Suppl): 54-55.
- 39.K. Bhavani-Shankar, H. Moseley, A. Y. Kumar, and Y. Delph, “Capnometry and anaesthesia,” Canadian Journal of Anaesthesia, vol. 39, no. 6, pp. 617–632, 1992
- 40. Garah J, Adiv OE, Rosen I, Shaoul R (2015) The value of Integrated Pulmonary Index (IPI) monitoring during endoscopies in children. J Clin Monit Comput 29: 773-778.
- 41. Riphaus A, Wehrmann T, Kronshage T, Geist C, Pox CP, Heringlake S, Schmiegel W, Beitz A, Meining A, Müller M, von Delius S. Clinical value of the Integrated Pulmonary Index(®) during sedation for interventional upper GI-endoscopy: A randomized, prospective tri-center study. Dig Liver Dis. 2017 Jan;49(1):45-49. doi: 10.1016/j.dld.2016.08.124. Epub 2016 Sep 1. PubMed PMID:27671621
- 42. Yıldırım Ar A, Abitağaoğlu S, Turan G, Karip CŞ, Akgün N, Boybeyi DM, Arı DE. Integrated Pulmonary Index (IPI) monitorization under sedation in cataract surgery with phacoemulsification technique. Int Ophthalmol. 2019 Sep;39(9):1949-1954. doi: 10.1007/s10792-018-1024-x. Epub 2018 Oct 4. PubMed PMID: 30284695.
Year 2020,
Volume: 19 Issue: 3, 109 - 115, 30.12.2020
Abstract
References
- 1. World Health Organization. Nutritional anaemias: Report of a WHO scientific group. Geneva, Switzerland: World Health Organization; 1968.
- 2. World Health Organization. Assessing the Iron Status of Populations, Including Literature Reviews: Report of a Joint World Health Organization/Centers for Disease Control and Prevention Technical Consultation on the Assessment of Iron Status at the Population Level. 2nd Ed. 2004.
- 3. Kassebaum NJ, Jasrasaria R, Naghavi M, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood 2014;123:615–24.
- 4. Pang WW, Schrier SL. Anemia in the elderly. Curr Opin Hematol 2012;19:133–40.
- 5.Stephens MR, Hopper AN, White SR, et al. Colonoscopy first for iron-deficiency anemia: a number needed to investigate approach. Q J Med 2006;99:389–95.
- 6. Pongprasobchai S, Sriprayoon T, Manatsathit S. Prospective Evaluation of Gastrointestinal Lesions by Bidirectional Endoscopy in Patients With Iron Deficiency Anemia. J Med Assoc Thai. 2011 Nov;94(11):1321-6.
- 7. Schlag C, Wörner A, Wagenpfeil S, Kochs EF, Schmid RM, et al. (2013) Capnography improves detection of apnea during procedural sedation for percutaneous transhepatic cholangiodrainage. Can J Gastroenterol 27: 582-586.
- 8.American Society of Anesthesiologists. Practice guidelines for sedation and analgesia by nonanesthesiologists. http://asahq.org/publicationsAndServices/practic eparam.ht
- 9. Dumonceau JM, Riphaus A, Aparicio JR, Beilenhoff U, Knape JT, et al. (2010) European Society of Gastrointestinal Endoscopy, European Society of Gastroenterology and Endoscopy Nurses and Associates, and the European Society of Anaesthesiology Guideline: Non-anesthesiologist administration of propofol for GI endoscopy. Endoscopy 42: 960-974.
- 10. Galvagno SM, Kodali BS (2009) Critical monitoring issues outside the operating room. Anesthesiology Clin 27: 141-156
- 11. Soto RG, Fu ES, Vila H Jr, Miguel RV. Capnography accurately detects apnea during monitored anesthesia care. Anesth Analg. 2004 Aug;99(2):379-82, table ofcontents. PubMed PMID: 15271710.
- 12. Srinivasa V, Kodali BS. Capnometry in the spontaneously breathing patient. Curr Opin Anaesthesiol. 2004 Dec;17(6):517-20. PubMed PMID: 17031088
- 13. Bhananker SM, Posner KL, Cheney FW, Caplan RA, Lee LA, Domino KB. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology. 2006 Feb;104(2):228-34. PubMed PMID: 16436839.
- 14. Arora S, Singh PM,Goudra BG, Sinha AC. Changing trends of hemodynamic monitoring in ICU–from invasivetonon-invasive methods: Are we there yet? Int J Crit Il ln Inj Sci. 2014; 4:168-77.
- 15. Small heer BA.Technology and monitoring patients at the bedside. Nurs Clin North Am.2015;50: 257-68.
- 16. Dar AQ, Shah ZA. Anesthesia and sedation in pediatric gastrointestinal endoscopic procedures: A review. World J Gastrointest Endosc 2010; 2 (7): 257-262,
- 17. Ronen M, Weissbrod R, Overdyk FJ, Ajizian S. Smart respiratory monitoring: clinical development and validation of the IPI™ (Integrated Pulmonary Index) algorithm. Journal of Clinical Monitoring and Computing. 2016. https://doi.org/10.1007/s10877-016-9851-7
- 18. Behrens A, Kreuzmayr A, Manner H, et al. Acute sedation-associated complications in GI endoscopy (ProSed 2 Study): results from the prospective multicentre electronic registry of sedation-associated complications [published online ahead of print, 2018 Jan 3]. Gut. 2018;gutjnl-2015-311037. doi:10.1136/gutjnl-2015-311037
- 19.Leslie K, Allen ML, Hessian EC, et al. Safety of sedation for gastrointestinal endoscopy in a group of university-affiliated hospitals: a prospective cohort study. Br J Anaesth. 2017;118(1):90‐99. doi:10.1093/bja/aew393
- 20. http://asahq.org
- 21. (2002) Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 96: 1004-1017.
- 22. Pang WW, Schrier SL. Anemia in the elderly. Curr Opin Hematol 2012;19:133–40.
- 23.Stephens MR, Hopper AN, White SR, et al. Colonoscopy first for iron-deficiency anemia: a number needed to investigate approach. Q J Med 2006;99:389–95.
- 24. Serefhanoglu S, Buyukasik Y, Emmungil H, Sayinalp N, Haznedaroglu,IC, Goker H, Aksu S, Ozcebe OI. Identification of Clinical and Simple Laboratory Variables Predicting Responsible Gastrointestinal Lesions in Patients With Iron Deficiency Anemia. Int J Med Sci. 2010 Dec 28;8(1):30-8.doi: 10.7150/ijms.8.30.
- 25.Goudra BG, Singh PM, Penugonda LC, Speck RM, Sinha AC. Significantly reduced hypoxemic events in morbidly obese patients undergoing gastrointestinal endoscopy: Predictors and practice effect. J Anaesthesiol Clin Pharmacol. 2014;30(1):71‐77. doi:10.4103/0970-9185.125707
- 26. 75 Million Endoscopies Performed Annually According to iData Research Procedure Analysis. Available at: https://idataresearch.com/75-million-endoscopies-performed-annually-according-to-idata-research-procedure-analysis/ (Accessed on February 04, 2019)
- 27.Sharma VK, Nguyen CC, Crowell MD, Lieberman DA, de Garmo P, Fleischer DE. A national study of cardiopulmonary unplanned events after GI endoscopy.Gastrointest Endosc. 2007 Jul;66(1):27-34. PubMed PMID: 17591470
- 28. Goudra B, Nuzat A, Singh PM, Borle A, Carlin A, Gouda G. Association between Type of Sedation and the Adverse Events Associated with Gastrointestinal Endoscopy: An Analysis of 5 Years’ Data from a Tertiary Center in the USA. Clin Endosc. 2017;50(2):161-169. doi:10.5946/ce.2016.019.
- 29. Vargo, J. J., Niklewski, P. J., Williams, J. L., Martin, J. F., & Faigel, D. O. Patient safety during sedation by anesthesia professionals during routine upper endoscopy and colonoscopy: an analysis of 1.38 million procedures. Gastrointestinal endoscopy, 2017; 85(1), 101-108. DOI:10.1016/j.gie.2016.02.007
- 30. Leslie, K., Allen, M. L., Hessian, E. C., Peyton, P. J., Kasza, J., Courtney, A., et.alSafety of sedation for gastrointestinal endoscopy in a group of university-affiliated hospitals: a prospective cohort study. BJA: British Journal of Anaesthesia, 2016; 118(1), 90-99. DOI:10.1093/bja/aew393
- 31.Wang CY, Ling LC, Cardosa MS, Wong AK, Wong NW (2000) Hypoxia during upper gastrointestinal endoscopy with and without sedation and the effect of pre-oxygenation on oxygen saturation. Anaesthesia 55: 654-658.
- 32.Reed MW, O'Leary DP, Duncan JL, Majeed AW, Wright B, et al. (1993) Effects of sedation and supplemental oxygen during upper alimentary tract endoscopy. Scand J Gastroenterol 28: 319-322.
- 33. Deitch K, Miner J, Chudnofsky CR, Dominici P, Latta D. Does end tidal CO2 monitoring during emergency department procedural sedation and analgesia with propofol decrease the incidence of hypoxic events? A Randomized, Controlled Trial. Ann Emerg Med 2010; 55: 258-64. DOI:10.1016/j.annemergmed.2009.07.030
- 34.ASA Standards for Basic Anesthetic Monitoring Approved by the ASA House of Delegates on October 21, 1986, and last amended on October 20, 2010 with an effective date of July 1, 2011.
- 35. van Loon K, van Rheineck Leyssius AT, van Zaane B, Denteneer M, Kalkman CJ(2014) Capnography During Deep Sedation with Propofol by Nonanesthesiologists: A Randomized Controlled Trial. Anesth Analg 119: 49-55
- 36. Wadhwa V, Gupta K, Vargo JJ. Monitoring standards in sedation and analgesia: the odyssey of capnography in sedation for gastroenterology procedures. Curr Opin Anaesthesiol. 2019 Aug;32(4):453-456. doi: 10.1097/ACO.0000000000000756. Review. PubMed PMID: 31169549.
- 37. Lightdale R, Fredette M, Atmadja M, Heard L, Jiang H. (2010) M1563:Pilot Study of the Smart Capnography Integrated Pulmonary Index™ in a pediatric gastroenterology procedure unit. Gastrointest Endosc 71:AB255.
- 38. Restrepo RD, Otaibi AA, Wittnebel L, Shammari YA, Ismaeil T (2013) Correlation between ABG parameters and the integrated pulmonary indexbin a medical-surgical ICU in saudi arabia. Anesthesia and Analgesia 117 (4S Suppl): 54-55.
- 39.K. Bhavani-Shankar, H. Moseley, A. Y. Kumar, and Y. Delph, “Capnometry and anaesthesia,” Canadian Journal of Anaesthesia, vol. 39, no. 6, pp. 617–632, 1992
- 40. Garah J, Adiv OE, Rosen I, Shaoul R (2015) The value of Integrated Pulmonary Index (IPI) monitoring during endoscopies in children. J Clin Monit Comput 29: 773-778.
- 41. Riphaus A, Wehrmann T, Kronshage T, Geist C, Pox CP, Heringlake S, Schmiegel W, Beitz A, Meining A, Müller M, von Delius S. Clinical value of the Integrated Pulmonary Index(®) during sedation for interventional upper GI-endoscopy: A randomized, prospective tri-center study. Dig Liver Dis. 2017 Jan;49(1):45-49. doi: 10.1016/j.dld.2016.08.124. Epub 2016 Sep 1. PubMed PMID:27671621
- 42. Yıldırım Ar A, Abitağaoğlu S, Turan G, Karip CŞ, Akgün N, Boybeyi DM, Arı DE. Integrated Pulmonary Index (IPI) monitorization under sedation in cataract surgery with phacoemulsification technique. Int Ophthalmol. 2019 Sep;39(9):1949-1954. doi: 10.1007/s10792-018-1024-x. Epub 2018 Oct 4. PubMed PMID: 30284695.
There are 42 citations in total.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | December 30, 2020 |
| Published in Issue | Year 2020 Volume: 19 Issue: 3 |
test-5