Comparison of two supplemental oxygen methods during gastroscopy with propofol mono-sedation in patients with a normal body mass index

Abstract

BACKGROUND Hypoxemia due to respiratory depression and airway obstruction during upper gastrointestinal endoscopy with sedation is a common concern. The Wei nasal jet tube (WNJT) is a new nasopharyngeal airway with the ability to provide supraglottic jet ventilation and oxygen insufflation via its built-in wall channel. The available evidence indicates that with a low oxygen flow, compared with nasal cannula, the WNJT does not decrease the occurrence of hypoxemia during upper gastrointestinal endoscopy with propofol sedation. To date, there has been no study assessing the performance of WNJT for supplemental oxygen during upper gastrointestinal endoscopy with sedation when a moderate oxygen flow is used. AIM To determine whether the WNJT performs better than the nasal prongs for the prevention of hypoxemia during gastroscopy with propofol mono-sedation when a moderate oxygen flow is provided in patients with a normal body mass index. METHODS This study was performed in 291 patients undergoing elective gastroscopy with propofol mono-sedation. Patients were randomized into one of two groups to receive either the WNJT (WNJT group, n = 147) or the nasal cannula (nasal cannula group, n = 144) for supplemental oxygen at a 5-L/min flow during gastroscopy. The lowest SpO 2 during gastroscopy was recorded. The primary endpoint was the incidence of hypoxemia or severe hypoxemia during gastroscopy. RESULTS The total incidence of hypoxemia and severe hypoxemia during gastroscopy was significantly decreased in the WNJT group compared with the nasal cannula group ( P = 0.000). The lowest median SpO 2 during gastroscopy was significantly higher (98%; interquartile range, 97-99) in the WNJT group than in the nasal cannula group (96%; interquartile range, 93-98). Epistaxis by device insertion in the WNJT group occurred in 7 patients but stopped naturally without any treatment. The two groups were comparable in terms of the satisfaction of physicians, anesthetists and patients. CONCLUSION With a moderate oxygen flow, the WNJT is more effective for the prevention of hypoxemia during gastroscopy with propofol mono-sedation compared with nasal prongs, but causing slight epistaxis in a few patients.

Reply to “Evaluation of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy: Double‐blind randomized control trial” by Martín‐Marcos et al.

“…Due to the blocking of upper airway sensory receptors, topical lidocaine may often result in postoperative pharyngeal discomfort, including dryness and dysphagia, especially after a short procedure 3 . We believe that this study would have provided more useful data about the effectiveness of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy if the design had included a postoperative assessment of patients’ satisfaction, as performed in previous studies 4,5 …”

“…3 We believe that this study would have provided more useful data about the effectiveness of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy if the design had included a postoperative assessment of patients' satisfaction, as performed in previous studies. 4,5…”

Comparing performance of Wei nasal jet tube and nasal cannula during flexible bronchoscopy with sedation

“…Because bleeding by slight nasal injury cannot be noted by visual examination we consider that for patients undergoing the flexible bronchoscopy, endoscopy is a convenient and accurate method to define the occurrence and severity of nasal bleeding. 6 In addition, a subjective scoring system of endoscopy can also be used to evaluate the severity of nasal bleeding. 8 Finally, the bronchoscopist satisfaction score was significantly increased in the SJOV group compared with the NCO group, but the mean inter-group difference of bronchoscopist satisfaction score only was 0.4.…”

“…5 Publications to date indicate that in patients undergoing gastroscopy with sedation, the sole use of the WNJ as a nasopharyngeal airway for supplementing oxygen with a moderate flow of 5 l min À1 can achieve the same efficacy as the WNJ for SJOV with a low oxygen flow of 2 l min À1 in decreasing the incidence of hypoxaemia. 6,7 That is, SJOV with the WNJ may be unnecessary if an increased oxygen flow is used during painless endoscopy with sedation. We believe that the results would have been different if an increased oxygen flow was used in the NCO group.…”

Sedation strategy for retrograde cholangiopancreatography in older patients

“…The authors provided the details of ERCP-and sedation-related adverse events occurring on the day of the procedure or on the day after the procedure, but they did not assess the satisfaction levels of patients, anesthesiologists and endoscopists, as performed in other studies. 4,5 In fact, satisfaction levels with the performance of the overall procedure reported by operators and patients are very important for determining clinical availability of interventions. 6 Furthermore, these variables are very easily measured with a numeric rating scale (0, very unsatisfactory; 10, very satisfactory).…”