Explosive Vomiting Associated with Proximal Colonic Distention during a Difficult Propofol-Assisted Colonoscopy

We present a case of explosive vomiting associated with the extensive manipulation of the proximal colon during a difficult colonoscopy procedure. The cause of vomiting in this case may have been multifactorial; however, proximal colonic distention was the most likely factor because the onset of vomiting coincided with proximal colonic manipulation and happened without any prodromal signs, coughing, and airway obstruction. Propofol, the sedative most commonly administered to the patient during colonoscopy, allows for a deep state of sedation, and consequently extensive colonic distention and scope manipulation. Colonic distention may lead to a higher risk of vomiting. We reviewed the neurocircuitry associated with vomiting and discussed why proximal colonic distention may increase the risk of vomiting. We emphasize vigilance during the manipulation of the proximal colon because vomiting increases the potential for aspiration pneumonitis and pneumonia in patients under deep propofol sedation with attenuated airway responses.

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Respiratory adverse events associated with deep propofol sedation during upper gastrointestinal procedures in children

Global Journal of Anesthesiology ◽

10.17352/2455-3476.000053 ◽

2021 ◽

pp. 008-012

Author(s):

Novotny William E ◽

Nguyen Khanh ◽

Jose Folashade ◽

Haislip Dynita ◽

Grothmann Gregg A ◽

...

Keyword(s):

Adverse Events ◽

Airway Obstruction ◽

Upper Airway ◽

Upper Airway Stimulation ◽

Propofol Sedation ◽

Respiratory Events ◽

Unknown Risk ◽

Advanced Airway ◽

Respiratory Event ◽

Impedance Probe

Background/Aims: Upper airway stimulation with endoscopes and pH-impedance probes during deep propofol sedation confers unknown risk for associated respiratory adverse airway events. This report quantifies frequencies of such events and airway rescue interventions associated with Esophagogastroduodenoscopies (EGD) and multi-channel intraluminal acid detection impedance probe (MIIP) placements. Methods: This was a prospective observational study regarding occurrence of adverse respiratory events in 42 children undergoing propofol sedated EGDs and MIIP placements: Group 1. (n=21 EGDs), Group2 (n=21 EGDs before MIIP), Group 3. (n=21 during MIIP). Results: All procedures were successfully completed using deep propofol sedation. Respiratory events were transient and associated with no morbidity or mortality. Nearly half of each group experienced a respiratory event. “Partial airway obstruction” during 42 EGDs occurred in 28.6% and responded to simple airway interventions. “Complete airway obstruction” occurred during 1/42 EGDs and 2/21 MIIPs. Throughout MIIP placement, endoscopic visualization of the glottis was maintained and unnecessary stimulation of the glottis was avoided; nonetheless, complete airway obstruction occurred in 2/21. Advanced airway rescue maneuvers were not required in either instance. Conclusions: Respiratory adverse events commonly occurred during EGDs and MIIP placements. All events were successfully rescued by simple airway interventions.

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Methacholine-induced pulmonary gas trapping in guinea pigs, hamsters, mice, and rats

Journal of Applied Physiology ◽

10.1152/jappl.1995.79.6.2148 ◽

1995 ◽

Vol 79 (6) ◽

pp. 2148-2153 ◽

Cited By ~ 12

Author(s):

P. W. Stengel ◽

C. A. Yiamouyiannis ◽

R. L. Obenchain ◽

S. L. Cockerham ◽

S. A. Silbaugh

Keyword(s):

Sodium Chloride ◽

Airway Obstruction ◽

Guinea Pigs ◽

Brown Norway ◽

Sprague Dawley ◽

Fischer 344 ◽

Gas Trapping ◽

Airway Responses ◽

Norway Rats

Postmortem pulmonary gas trapping was investigated as an index of in vivo airway obstruction following methacholine inhalation in four different rodent species. Male guinea pigs (Hartley), hamsters (golden Syrian), mice (A/J, BALB/c, and ICR), and rats (Brown-Norway, Fischer 344, Lewis, and Sprague-Dawley) were exposed to aerosols of methacholine or sodium chloride. Maximum excised lung gas volumes (ELGV) of methacholine-exposed guinea pigs, hamsters, mice, and rats were 2.3–8.7 times those of sodium chloride-treated animals. Mean ELGV values of sodium chloride-exposed animals ranged from 1.50 +/- 0.20 ml/kg for guinea pigs to 2.75 +/- 0.20 ml/kg for Brown-Norway rats. Although all species responded to methacholine, guinea pigs were the most responsive, with approximately 1.6 microgram/kg of inhaled methacholine needed to increase ELGV to 200% of control. Compared with guinea pigs, hamsters, mice, and rats were 11- to 1,395-fold less responsive. Although hamsters, mice, and rats are less sensitive than guinea pigs to the airway-obstructive effects of methacholine, pulmonary gas trapping appears useful as a measure of airway responses in these species.

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