Predictors of Hypoxemia Developed During Fiberoptic Bronchoscopy Under Monitored Anesthesia Care.

SESSION TYPE: Bronchoscopy and Interventional Procedures PostersPRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PMPURPOSE: Sedation is currently suggested in all patients during the bronchoscopy to facilitate the diagnostic procedures and to improve patients' comfort unless contraindications exist. However, sometimes unexpected hypoxemia develops during the bronchoscopy using sedatives. We conducted this prospective study to determine the incidence and predictors of hypoxemia during the fiberoptic bronchoscopy under monitored anesthesia care.METHODS: From June 2011 to October 2011, consecutive patients who underwent bronchoscopy under MAC anesthesia in Seoul National University Bundang hospital were prospectively recruited. Before the bronchoscopy, all participants were requested to answer the Korean version of Berlin, STOP questionnaires for sleep apnea screening, and their neck circumferences were measured. Hypoxemia was defined as desaturation (SpO2 <90%), not fully recovered by verbal stimulation, needed oxygen increment, mandible support, artificial airway insertion, mask ventilation or discontinuation of procedure temporally or permanently.RESULTS: In total, 363 patients were enrolled. Their median age was 62 years (range;15-89). 190 patients (66.2%) were male. During bronchoscopy, any desatruation events (SpO2 <90%) were occurred in 230 patients (63.4%). Hypoxemia was developed in 144 patients (39.7%). Risk for hypoxemia was increased in patients with age≥50 years (OR 2.177;p<0.003), body mass index≥25Kg/m2 (OR 1.868; p=0.016), hypertension (OR 1.639;p=0.027), baseline hypoxemia before procedure (OR 3.262;p=0.013), snoring after anesthesia induction (OR 3.154;p=0.001), high risk group for sleep apnea in questionnaires (OR 2.212;p=0.004). Dose of sedatives, baseline lung function, neck circumference, duration or number of procedures were not associated with hypoxemia. Multivariate analysis revealed that age≥50 years (adjusted OR 1.029, 95% CI 1.072-3.534;p=0.001), snoring after induction(adjusted OR 2.982; 95% CI 1.600-5.556;p=0.001), high risk group for sleep apnea in questionnaires (1.736 ;95% CI 1.013-2.976;p=0.045) were the independent risk factors for hypoxemia during bronchoscopy.CONCLUSIONS: During bronchoscopy with MAC anesthesia, hypoxemia developed in almost 40% of the patients. High risk patients for hypoxemia must be screened and carefully monitored during fiberoptic bronchoscopy MAC anesthesiaCLINICAL IMPLICATIONS: This study suggested that sleep apnea screening questionnaires could be used as a screening tool for hisk risk patients of hypoxemia developed during fiberotic bronchoscopy under MAC anesthesia.DISCLOSURE: The following authors have nothing to disclose: Hyo-Jeong Lim, Young-Jae Cho, Jong Sun Park, Hoil Yoon, Jae-ho Lee, Choon-Taek Lee, Sei Won LeeNo Product/Research Disclosure InformationDivision of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seongnam-si, Republic of Korea.