Impact of Obesity on Hypoxemia During Deep Dental Sedation for Paediatric and Adult Patients With Intellectual Disabilities: CT90 as an Outcome

Objective

Using cumulative time spent with SpO₂ < 90% (CT90) as an indicator, this retrospective observational study aimed to assess the incidence and severity of hypoxemia during deep intravenous sedation for patients with intellectual disabilities. Additionally, it intended to identify patient characteristics and anaesthesia-related factors independently associated with CT90.

Study Design

The pulse oximetry data were collected every 5 s during intravenous dental sedation in 144 patients with intellectual disabilities. Hypoxemia and severe hypoxemia were defined as SpO₂ < 90% and CT90 > 1%, respectively. Multiple linear regression analysis was performed to identify independent risk indicators associated with the occurrence of hypoxemia.

Results

More than one episode of hypoxemia occurred in 62% (89/144) of patients. CT90 was 1.9 ± 4.8% during sedation and severe hypoxemia developed in 35% (50/144) of patients. BMI was a significant independent patient risk indicator for severe hypoxemia but accounted for only 28% of the variability in its incidence. Notably, the use of a BIS monitor, an appropriate dose of propofol and an extra suctioning device were identified as independent factors that could improve SpO₂ level.

Conclusion

Severe hypoxemia frequently occurred during intravenous sedation, particularly in obese patients with intellectual disabilities. Technical and pharmacological improvements of sedation strategies are essential.