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Gastrointestinal barotrauma — Clinical Guidelines

Overview

Gastrointestinal barotrauma refers to injuries caused by pressure changes affecting the gastrointestinal tract, often seen in diving or high-altitude scenarios, leading to conditions such as pneumoperitoneum or barodontalgia.

Diagnosis

Clinical symptoms include sudden abdominal pain, dysphagia, or oral discomfort during pressure changes.

Imaging studies (CT scans) are crucial for confirming pneumoperitoneum or other internal injuries 18.

Dental evaluations may be necessary to diagnose barodontalgia or dental barotraumas 18.

Management

Immediate cessation of pressure exposure and stabilization of the patient.

Supportive care including oxygen therapy and monitoring for respiratory and cardiovascular complications 1.

Surgical intervention may be required for significant pneumoperitoneum or other internal injuries 18.

Use of prophylactic measures such as dental protection in high-risk activities 18.

Special Populations

Pediatrics: Specific monitoring protocols are essential due to altered physiology; however, no specific studies in abstracts cover pediatric gastrointestinal barotrauma directly.

Elderly: Increased risk of complications; careful sedation practices and monitoring are advised 5.

Comorbidities: Patients with respiratory or cardiovascular conditions require heightened vigilance and tailored sedation protocols 1 5.

Key Recommendations

Implement capnography monitoring during gastrointestinal endoscopic procedures to reduce respiratory and cardiovascular adverse events (Evidence: Moderate) 1.

Use a nasal mask oxygen kit over regular nasal cannulas to potentially reduce the incidence of hypoxia during sedation (Evidence: Moderate) 3.

Tailor sedation protocols for elderly patients, considering the comparative safety of remimazolam versus propofol (Evidence: Moderate) 5.

Ensure thorough training and competency in sedation practices, especially for non-anaesthesiologist-administered propofol sedation (Evidence: Moderate) 14.

Consider the use of flumazenil cautiously for reversal of midazolam sedation post-endoscopy, evaluating its impact on recovery time (Evidence: Weak) 12 20.

References

1 Valbuena I, Sancho A, Alsina E, Brogly N, Gilsanz F. Does capnography improve safety in moderate-deep sedation for gastrointestinal endoscopic procedures provided by anaesthesiologists? A prospective cohort study. Journal of clinical monitoring and computing 2025. link 2 Abdullayev R, Kelleci Y, Halis A, Girgin S, Saracoglu A, Umuroglu T. Integrated pulmonary index in pediatric sedation for endoscopy: a prospective cohort study. Cirugia y cirujanos 2025. link 3 Cheng X, Zhang X, Zhang J, Hu Z, Zhang J, Lian Q et al.. Efficacy of a nasal mask oxygen kit versus regular nasal cannula in sedated gastrointestinal endoscopy: a multicentre, randomised clinical trial. BMJ open gastroenterology 2025. link 4 Liou JY, Wang HY, Kuo IT, Tsou MY, Chang WK, Ting CK. A New Method for Comprehensive Analysis of Benzodiazepine, Opioid, and Propofol Interactions and Dose Selection Rationales in Gastrointestinal Endoscopy Sedation. Anesthesia and analgesia 2025. link 5 Terres MT, Assis ML, DA Silveira CB, Amaral S. Remimazolam versus propofol for endoscopy sedation in elderly patients: a systematic review, meta-analysis and trial sequential analysis. Minerva anestesiologica 2024. link 6 Han DS, Ingram JW, Gorroochurn P, Badalato GM, Anderson CB, Joice GA et al.. The State of Urotrauma Education Among Residency Programs in the United States: A Systematic Review and Meta-Analysis. Current urology reports 2023. link 7 Adams MA, Rubenstein JH, Forman JH. Organizational Factors Driving Selection of Gastrointestinal Endoscopic Sedation in Veterans Health Administration and Community Settings. The American journal of gastroenterology 2023. link 8 Lois FJ, Massart Q, Warner DO, Malengreaux C, Knops M, Nyssen AS et al.. Driving performance of outpatients achieving discharge criteria after deep sedation is worse than these of their escort-driver: a prospective observational study on simulator. Acta gastro-enterologica Belgica 2023. link 9 Morey AF, Broghammer JA, Hollowell CMP, McKibben MJ, Souter L. Urotrauma Guideline 2020: AUA Guideline. The Journal of urology 2021. link 10 Liou JY, Tsou MY, Obara S, Yu L, Ting CK. Plasma concentration based response surface model predict better than effect-site concentration based model for wake-up time during gastrointestinal endoscopy sedation. Journal of the Formosan Medical Association = Taiwan yi zhi 2019. link 11 Wadhwa V, Gupta K, Vargo JJ. Monitoring standards in sedation and analgesia: the odyssey of capnography in sedation for gastroenterology procedures. Current opinion in anaesthesiology 2019. link 12 Lee SP, Sung IK, Kim JH, Lee SY, Park HS, Shim CS. Efficacy and safety of flumazenil injection for the reversal of midazolam sedation after elective outpatient endoscopy. Journal of digestive diseases 2018. link 13 Rex DK. Endoscopist-Directed Propofol. Gastrointestinal endoscopy clinics of North America 2016. link 14 Da B, Buxbaum J. Training and Competency in Sedation Practice in Gastrointestinal Endoscopy. Gastrointestinal endoscopy clinics of North America 2016. link 15 Parker DC, Kocher N, Mydlo JH, Simhan J. Trends in Urology Residents' Exposure to Operative Urotrauma: A Survey of Residency Program Directors. Urology 2016. link 16 Jensen JT, Savran MM, Møller AM, Vilmann P, Hornslet P, Konge L. Development and validation of a theoretical test in non-anaesthesiologist-administered propofol sedation for gastrointestinal endoscopy. Scandinavian journal of gastroenterology 2016. link 17 Liou JY, Ting CK, Huang YY, Tsou MY. Previously published midazolam-alfentanil response surface model cannot predict patient response well in gastrointestinal endoscopy sedation. Journal of the Chinese Medical Association : JCMA 2016. link 18 Zanotta C, Dagassan-Berndt D, Nussberger P, Waltimo T, Filippi A. Barodontalgias, dental and orofacial barotraumas: a survey in Swiss divers and caisson workers. Swiss dental journal 2014. link 19 Huang YY, Chu YC, Chang KY, Wang YC, Chan KH, Tsou MY. Performance of AEP Monitor/2-derived composite index as an indicator for depth of sedation with midazolam and alfentanil during gastrointestinal endoscopy. European journal of anaesthesiology 2007. link 20 Chang AC, Solinger MA, Yang DT, Chen YK. Impact of flumazenil on recovery after outpatient endoscopy: a placebo-controlled trial. Gastrointestinal endoscopy 1999. link70384-6) 21 McMurphy RM, Hodgson DS, Cribb PH. Modification of a nonrebreathing circuit adapter to prevent barotrauma in anesthetized patients. Veterinary surgery : VS 1995. link

Gastrointestinal barotrauma