Anaesthesia
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Randomized Controlled Trial Multicenter Study Clinical Trial
Hypoxia during upper gastrointestinal endoscopy with and without sedation and the effect of pre-oxygenation on oxygen saturation.
In Study A, the incidence of arterial oxygen desaturation was studied using pulse oximetry (SaO2) in 100 sedated and 100 nonsedated patients breathing room air who underwent diagnostic upper gastrointestinal endoscopy. Hypoxia (SaO2 92% or less of at least 15 s duration) occurred in 17% and 6% of sedated patients and nonsedated patients, respectively (p < 0.03). Mild desaturation (SaO2 94% or less and less than 15 s duration) occurred in 47% of sedated patients compared with 12% of nonsedated patients (p < 0.001). ⋯ Sedation significantly increases the incidence of desaturation and hypoxia. Supplementary nasal oxygen at 4 1 x min(-1) in sedated patients abolishes desaturation and hypoxia. Pre-oxygenation confers no additional benefit.
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In the South Thames (West) region of the United Kingdom, during a 6-year period from 1993 to 1998, there was a significant increase in the Caesarean section rate accompanied by a significant decrease in the use of general anaesthesia for operative delivery. During this time, there were 36 failed tracheal intubations occurring in 8970 obstetric general anaesthetics (incidence 1/249). There was no significant difference in the incidence of failed tracheal intubation in each of the six years. In 24 of the 26 cases for which the patients' notes could be examined, there was either no recording of preoperative assessment, a failure to follow an accepted protocol for failed tracheal intubation, or no follow-up.