Low SaO2 Readings

[JoyRich]

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My wife had a low SaO2 reading after her Colonoscopy and referred her to our family doctor who then referred her to a lung specialist. After many tests at the hospital; ECHO REAL-TIME, DOPPLER ECHOCARDIOGRAM, DOPPLER COLOR FLOW, ECHOCARDIOGRAM, PULMONARY FUNCTION, CT BODY SCAN, ULTRASOUND, and another PULMONARY FUNCTION test, the doctor still does not have an answer to the following:

Her SaO2 readings are in the low 90's when she is sitting or riding in the car.
When she is standing, the reading increase to 94% and above. When she exercises, the readings are in the high 90's. When she breathes in through her nose and out through her mouth while sitting, the readings increase to 94% and above.

She is 62 years old and has epilepsy and is on depression medicine. She takes the following medications; Lamictal, Dilantin, Phenobarbital, Paxil, and Rispedal.
Two other pills she takes every day are Centrum Silver (2), and Caltrate 600.

We would appreciate any comments, ideas or other situations similar to this one.

Thank you,
Richard McJunkin

 

[Seaglass]

The key question is does she, or did she, smoke.

 

[doc05]

the key question is why look for medical advice in a discussion forum?

 

[Cristagali]

Sedation during the colonoscopy could be a possible cause to decreased Sao2. But it's probably something "anatomical, physio" since the "knees closer to the chest" )colonoscopy, sitting position) increasing flow/pressure to RV and PA, etc, etc, seems to worsen her readings. Interesting case. BUT i second the above post, I would consult a specialist, not a medical student forum. IMO GL 👍

 

[cooldreams]

i have bees wax.

😀

 

[deleted6669]

is she morbidly obese?
think pickwickian syndrome.......

 

[pockey]

the key question is why look for medical advice in a discussion forum?

^

 

[UTSouthwestern]

Interesting situation. I'm assuming she is not obese as there would be too many obvious choices. Impressive list of tests especially since a simple blood gas was not one of the tests you listed. I am assuming that all of the more expensive tests were normal and so with no evidence of cardiopulmonary compromise, you may want to look into a more peripheral or hematologic source of pathology. Peripheral vasoconstriction? Blood dyscrasia? or Red herring?

 

[omarsaleh66]

Interesting situation. I'm assuming she is not obese as there would be too many obvious choices. Impressive list of tests especially since a simple blood gas was not one of the tests you listed. I am assuming that all of the more expensive tests were normal and so with no evidence of cardiopulmonary compromise, you may want to look into a more peripheral or hematologic source of pathology. Peripheral vasoconstriction? Blood dyscrasia? or Red herring?

UTSouthwestern

I know u are an anesthesiologist and deal with these situations. When SaO2 is in low 90's like 91, cant u fix with frequent bronchodilator therapy (FBT) for 4 hours? Did I make any sense? I just wrote about this in a pediatric airway paper but it dealt with a differnt scenario. Just wondering if the same thing would apply here as a treatment. EDIT: Ok my question is can we treat the patient with FBT? or does only work with asthmatic children. Sorry i wasnt so clear before.

Thanks

Omar

 

[omarsaleh66]

Here is an excerpt from a colonscopy paper that ramzi, amir, me and Dr Kaye wrote last year:

In a recent study conducted in Germany, the effects of
sedation on the cardiopulmonary system of patients
undergoing colonoscopy were explored.61 In this study,
2.4% of sedated patients experienced adverse cardiopulmonary
side effects. Specifically, 1% had short bouts of
oxygen desaturation and 0.9% had vagovagal reactions,
including low blood pressure and heart rate. Other studies
have indicated that sedation affects the autonomic nervous
system, and such effects may lead to complications.
For example, midazolam potentiates the sympathetic nervous
system and thereby may exacerbate cardiovascular
incidents during colonoscopy.62 In a study of 180 patients,
midazolam lowered the systolic and diastolic blood pressures,
resulting in hypotension (systolic blood pressure
<100 mm Hg). Sedation with midazolam can significantly
decrease arterial oxygen saturation and increase the
occurrence of hypotension. Although these complications
may arise, colonoscopy with or without sedation is still considered safe.63 However, close observation of a patient
sedated during an endoscopic procedure is warranted.62
A study of 53 patients showed that hazardous levels of
sedation may be reached in the first 24 hours after the
operation. Continued monitoring by family or friends in the
outpatient setting is indicated.

Please click here for the full paper.

http://www.anesthesiologynews.com/articles/8424/pdf/8424.pdf?CFID=267153&CFTOKEN=30403289