Modified Manual Chest Compression for Prevention and Treatment of Respiratory Depression in Patients Under Deep Sedation During Upper Gastrointestinal Endoscopy: Two Randomized Controlled Trials

Abstract

BACKGROUND: We aimed to determine the preventive and therapeutic efficacy of modified manual chest compression (MMCC), a novel noninvasive and device-independent method, in reducing oxygen desaturation events in patients undergoing upper gastrointestinal endoscopy under deep sedation. METHODS: A total of 584 outpatients who underwent deep sedation during upper gastrointestinal endoscopy were enrolled. In the preventive cohort, 440 patients were randomized to the MMCC group (patients received MMCC when their eyelash reflex disappeared, M1 group) or control group (C1 group). In the therapeutic cohort, 144 patients with oxygen desaturation of a Spo 2 < 95% were randomized to MMCC group (patients who subsequently received MMCC, M2 group) or the conventional treatment group (C2 group). The primary outcomes were the incidence of desaturation episodes with an Spo 2 < 95% for the preventive cohort and the time spent below 95% Spo 2 for the therapeutic cohort. Secondary outcomes included the incidence of gastroscopy withdrawal and diaphragmatic pause. RESULTS: In the preventive cohort, MMCC reduced the incidence of desaturation episodes <95% (14.4% vs 26.1%; RR, 0.549; 95% confidence interval [CI], 0.37–0.815; P = .002), gastroscopy withdrawal (0% vs 2.29%; P = .008), and diaphragmatic pause at 30 seconds after propofol injection (74.5% vs 88.1%; RR, 0.846; 95% CI, 0.772–0.928; P < .001). In the therapeutic cohort, patients who received MMCC had a significantly shorter time spent below 95% Spo 2 (40 [20–69] seconds vs 91 [33–152] seconds, median difference [95% CI], −39 [−57 to −16] seconds, P < .001), a lower incidence of gastroscopy withdrawal (0% vs 10.4%, P = .018), and more enhanced diaphragmatic movement at 30 seconds after Spo 2 <95% (1.11 [0.93–1.4] cm vs 1.03 [0.7–1.24] cm; median difference [95% confidence interval], 0.16 [0.02–0.32] cm; P = .015). CONCLUSIONS: MMCC may exert preventive and therapeutic effects against oxygen desaturation events during upper gastrointestinal endoscopy.

Patient selection for nonoperating room anesthesia

“…In some cases, providers and patients may not even be in the same room. Although novel monitoring systems may assist providers, vigilance remains paramount [16,17]. Combining ergonomic limitations with sicker patients, it is no surprise that Schroeck et al [18 && ] found that NORA anesthesia providers report higher stress, workload, and anxiety.…”

Influence of Sedated Endoscopy on Colorectal Adenoma Detection Rate: A Multicenter Study

“…The anesthesiologist teams for the sedated endoscopy during the study period comprised of the same anesthesiologists at each center, and sedated endoscopy patients received propofol-based deep general anesthesia without tracheal intubation. 19,20 This team of anesthesiologists was responsible for the patient's anesthesia status, and kept the patient under deep sedation during the entire examination. Both the study and control data sets were obtained from the same group of patients, and were classified according to the sedation.…”