Prospective Single-Arm Study of Remifentanil-Propofol Anesthesia with Manual Right Hypochondrial Compression for Painless Gastroscopy in Obese Patients.

IF 5.1 2区医学 Q1 CHEMISTRY, MEDICINAL Drug Design, Development and Therapy Pub Date : 2025-02-11 eCollection Date: 2025-01-01 DOI:10.2147/DDDT.S498238

Mengxia Wang, Jieke Tang, Zhaojie Pan, Hongxue Jiang, Donghua Hu, Beibei Zhu, Zhaojia Liang, Xiangfeng Zhao, Yalan Li

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Abstract

Purpose: The provision of comfortable and safe environment for painless gastroscopy in obese patients is an urgent clinical problem. This study aimed to determine the efficacy and safety of the novel Li anesthetic protocol for obesity (LAPO) which included remifentanil-propofol regimen, manual right hypochondrial compression (MRHC), easy-to-create mask, and jaw thrust at preoperative painless gastroscopy in obese patients.

Patients and methods: This prospective, single-center, single-arm trial recruited 106 participants underwent LAPO for gastroscopy. The primary outcome was the incidence of hypoxemia (peripheral oxygen saturation [SpO₂]: 75% ≤ SpO₂ <90%, for >10 s and ≤60 s). Second outcomes included severe hypoxemia, the lowest SpO₂ (L-SpO₂), duration of hypoxemia, and other events.

Results: The 98 obese patients under LAPO, the median body mass index (BMI) was 39.2 kg/m² and the incidence of hypoxemia was 27.5%, while the conventional anesthetic protocol for obesity (CAPO) in the reference was 40.4% with BMI 31.4 kg/m². With the increase of class of obesity, a significant rise in the incidence of hypoxemia was observed, from class I by 11.8%, to 15.1% in class II, and 41.7% in class III. Paired t test showed that the L-SpO₂ was significantly higher than L-SpO₂ in overnight polysomnography (Nadir SpO₂) (92% vs 76%, P<0.001). Moreover, severe obstructive sleep apnea (OSA) was associated with a 4.019-fold higher risk of hypoxemia (Odds ratios [OR], 4.019; 95% confidence interval [CI], 1.184 to 14.610; P=0.028); diabetes was associated with a 4.790-fold higher risk of hypoxemia (OR, 4.790; 95% CI, 1.288 to 23.600; P=0.030).

Conclusion: Compared with CAPO, LAPO reduced the incidence of hypoxemia from 40.4% to 27.5%, so, LAPO was safe and effective for painless gastroscopy. The finding might provide some new schedules for anesthetic management in the absence of advanced airway support instruments.

Clinical trial registration: ChiCTR2300077889.

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雷米芬太尼-异丙酚麻醉加右肋软骨压迫用于肥胖患者无痛胃镜检查的前瞻性单臂研究。

目的：为肥胖患者提供舒适、安全的无痛胃镜检查环境是迫切需要解决的临床问题。本研究旨在确定肥胖症Li麻醉方案（LAPO）的有效性和安全性，该方案包括瑞芬太尼-异丙酚方案、手动右疑软骨压迫（MRHC）、易于制作的面罩和术前无痛胃镜检查时的下颌推力。患者和方法：这项前瞻性、单中心、单臂试验招募了106名接受LAPO胃镜检查的参与者。主要终点为低氧血症发生率（外周血氧饱和度[SpO2]: 75%≤SpO2 10 s和≤60 s），次要终点包括严重低氧血症、最低SpO2 （L-SpO2）、低氧血症持续时间和其他事件。结果：采用LAPO治疗的98例肥胖患者中位体重指数（BMI）为39.2 kg/m2，低氧血症发生率为27.5%，而参考文献采用常规麻醉治疗肥胖方案（CAPO）的肥胖患者中位体重指数为40.4%，BMI为31.4 kg/m2。随着肥胖等级的增加，低氧血症的发生率显著上升，从1级上升11.8%，到2级上升15.1%，到3级上升41.7%。配对t检验显示，夜间多导睡眠图（Nadir SpO2）的L-SpO2明显高于夜间多导睡眠图（Nadir SpO2）的L-SpO2 （92% vs 76%）。结论：与CAPO相比，LAPO将低氧血症的发生率从40.4%降低到27.5%，LAPO用于无痛胃镜检查是安全有效的。该发现可能为缺乏先进气道支持设备的麻醉管理提供一些新的时间表。临床试验注册：ChiCTR2300077889。

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来源期刊

Drug Design, Development and Therapy CHEMISTRY, MEDICINAL-PHARMACOLOGY & PHARMACY

CiteScore

9.00

自引率

0.00%

发文量

382

审稿时长

>12 weeks

期刊介绍： Drug Design, Development and Therapy is an international, peer-reviewed, open access journal that spans the spectrum of drug design, discovery and development through to clinical applications. The journal is characterized by the rapid reporting of high-quality original research, reviews, expert opinions, commentary and clinical studies in all therapeutic areas. Specific topics covered by the journal include: Drug target identification and validation Phenotypic screening and target deconvolution Biochemical analyses of drug targets and their pathways New methods or relevant applications in molecular/drug design and computer-aided drug discovery* Design, synthesis, and biological evaluation of novel biologically active compounds (including diagnostics or chemical probes) Structural or molecular biological studies elucidating molecular recognition processes Fragment-based drug discovery Pharmaceutical/red biotechnology Isolation, structural characterization, (bio)synthesis, bioengineering and pharmacological evaluation of natural products** Distribution, pharmacokinetics and metabolic transformations of drugs or biologically active compounds in drug development Drug delivery and formulation (design and characterization of dosage forms, release mechanisms and in vivo testing) Preclinical development studies Translational animal models Mechanisms of action and signalling pathways Toxicology Gene therapy, cell therapy and immunotherapy Personalized medicine and pharmacogenomics Clinical drug evaluation Patient safety and sustained use of medicines.