Glossopharyngeal nerve block for esophagogastroduodenoscopy in critically ill patients

Deep sedation during esophagogastroduodenoscopy [EGD] may not be well tolerated by critically ill patients. Glossopharyngeal nerve [GPN] block provides reliable pharyngeal anesthesia and can significantly reduce sedation requirements for these procedures. We report our successful experience with GPN block as the sole or main source of anesthesia for EGD in a series of nine critically ill patients

Comparison of [the STOP-Bang] and [the Modified Neck Circumference] obstructive sleep apnea screening questionnaires

This study was designed to determine the degree of correlation between two obstructive sleep apnea [OSA] questionnaires, the validated [STOP-Bang] questionnaire and [Flemons] Modified Neck Circumference [MNC]' questionnaire which had been used at our hospital for many years. With IRB approval and written informed patient consents, 197 adult outpatients presenting for gastroenterological procedures were randomly screened for OSA risk using both the STOP-Bang and the MNC questionnaires. Spearman's rank correlation coefficient was used to measure the statistical dependence of the scores calculated from the two questionnaires. The Spearman's correlation between the STOP-Bang questionnaire score and the MNC questionnaire score was 0.82 [p < 0.001]. There is a strong correlation between the STOP-Bang and the MNC questionnaires as demonstrated in this study. Our successful experience with the MNC questionnaire justify conduction of a randomized controlled trial to test the validity of the MNC questionnaire

prevalence of obstructive sleep apnea characteristics in patients with Barrett's esophagus

An increasing number of patients with Barrett's espophagus present for diagnostic and/or therapeutic upper GI endoscopy. It has been our impression that a large number of these patients have history and characteristics strongly suggestive of obstructive sleep apnea [OSA], and are, therefore, more challenging to sedate during the upper GI endoscopic procedures. This study was conducted to prospectively quantify the prevalence of OSA characteristics in patients with Barrett's esophagus. Consented patients with Barrett's esophagus were prospectively screened for obstructive sleep apnea [OSA] risk using the modified neck circumference questionnaire. The study demonstrated a statistically significant association between Barrett's esophagus and high OSA risk when compared to the general GI endoscopy population

Evaluation of dexmedetomidine/propofol anesthesia during upper gastrointestinal endoscopy in patients with high probability of having obstructive sleep apnea

Dexmedetomidine provides sedation with minimal respiratory depression which is a desirable characteristic in patients with obstructive sleep apnea [OSA]. This observational study prospectively evaluated the efficacy and safety of dexmedetomidine/ propofol anesthesia for patients with OSA characteristics without endotracheal intubation during upper gastrointestinal [GI] endoscopy. Twenty patients undergoing upper GI endoscopy who were considered high probability of having OSA based on an adjusted neck circumference greater than 48 were enrolled in the study. Dexmedetomidine 1 meg/kg bolus was given over 10 min followed by propofol boluses until adequate depth of anesthesia was achieved. Propofol infusion was used to maintain anesthesia. Blood pressure, heart rate, and O2 saturation were recorded before, during, and after the procedure. The endoscopists evaluated the anesthesia condition on a 10 points numerical scale. Post-Anesthesia Care Unit [PACU] time was recorded. The following day, patients were questioned about complications and were asked to evaluate their overall anesthesia experience on a 10 points numerical scale. Fifteen males and five females aged 51 +/- 8 years were enrolled. Their BMI was 34.7 +/- 8.4, and their adjusted neck circumference was 53.4 +/- 3.4. Propofol induction dose was 0.8 +/- 0.4 mg/kg; and PACU time was 67.5 +/- 26.7 min. Two patients developed transient hypoxemic episodes during the procedure. Transient hypotension was experienced by three patients during the procedure and three patients in PACU. The evaluation score was 9 +/- 1.7 by the endoscopists, and 8 i 2.3 by the patients. After discharge, 16 patients complained of drowsiness, two patients reported dysphoric symptoms, and one patient complained of dry mouth. Dexmedetomidine / propofol combination can provide satisfactory anesthesia for upper GI endoscopy in OSA patients. The technique provides an alternative to endotracheal intubation in these high risk patients. The prolonged induction and recovery times, however, may limit its routine use