Francesca Dimou, MD, Samantha Huynh, Gregory Dakin, MD, Alfons Pomp, MD, Zachary Turnbull, MD, Jon D Samuels, MD, Cheguevara Afaneh, MD. New York Presbyterian/ Weill Cornell
Introduction: Pre-operative esophagogastroduodenoscopy (EGD) is becoming routine practice in patients undergoing bariatric surgery. Many patients with morbid obesity have obstructive sleep apnea (OSA), which can worsen hypoxia during an EGD. In this study, we utilized the SuperNO2VA™device, a sealed nasal positive airway pressure mask designed to deliver high fraction inhaled oxygen and titratable positive pressure. We report our outcomes in patients undergoing preoperative screening EGD treated with this device compared to using conventional nasal cannula.
Methods: Between June 2016 and August 2017, we conducted a prospective observational study that included 56 consecutive patients who presented for EGD prior to bariatric surgery. At the discretion of the anesthesia team, airway management was done using either the SuperNO2VA™(N=26) device or conventional nasal cannula (N=30). Patient demographics and procedure details including baseline oxygenation saturation, procedure length and post-anesthesia care unit (PACU) length of stay were collected. Patient demographics and outcomes were compared between the two groups.
Results: The SuperNO2VA™ group had a lower median age compared to the control group (38.5 vs. 48.5 years, p = 0.04). These patients also had a higher body mass index (BMI) (47.4 vs. 40.5, IQR, p < 0.0001), higher ASA class (p=0.03), and were more likely to have OSA (53.9% vs. 26.7%, p = 0.04). Desaturation events were significantly lower in the SuperNO2VA™ group (11.5% vs. 46.7%, p = 0.004)and the median lowest oxygen saturation was higher in the SuperNO2VA™ group (100% vs. 90.5%, p < 0.0001). There was no difference in length of procedure time between the two groups, post-procedural oxygen saturations, or time spent in the PACU. One complication occurred in the control group, which was hypoxia requiring overnight admission
Discussion: This is the first study to report on use of the SuperNO2VA™ device in bariatric patients undergoing preoperative screening EGD. The use of the SuperNO2VA™ device offers a clinical advantage compared to the current standard of care. Our data demonstrate that patients with higher BMI, higher ASA classification, and OSA were more likely to have the SuperNO2VA™ device used; yet, paradoxically, these patients were less likely to have issues with desaturation events. Use of this device can optimize care in this challenging patient population by minimizing the risks of hypoventilation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93682
Program Number: S111
Presentation Session: Bariatric III – Optimizing Care and Pathways
Presentation Type: Podium