Prospective Evaluation of the Routine Use of a Nasopharyngeal Airway (Wendl Tube) during Endoscopic Propofol-Based Sedation

Abstract

Background/Aims: Insertion of a nasopharyngeal airway (NPA) during endoscopic sedation is only recommended in the event of respiratory problems. We evaluated the safety and efficacy of routine insertion of an NPA during sedation in gastrointestinal (GI) endoscopy. Methods: Between July 2009 and April 2012, patients with colonoscopy or expected longer-lasting or therapeutic upper GI endoscopy were pseudo-randomized in a weekly alternating fashion to perform sedation (midazolam in combination with propofol) with or without NPA insertion. The primary outcome measure was respiratory depression (oxygen saturation <90%). Secondary measures included hypotension (systolic blood pressure <90 mm Hg), bradycardia (heart rate <40 beats/min) or nasopharyngeal damage after NPA insertion. Results: 216 (106 females, mean age 60.7 ± 9.65 years) were enrolled. Colonoscopy was performed in 131 patients and upper endoscopy in 85 patients. In 105 patients an NPA was used (intervention group). Five (4.7%) of those patients showed minor nasopharyngeal injury. Respiratory depression (13.5 vs. 1.9%, p = 0.002) and hypotension (11 vs. 5%, p = 0.09) occurred more frequently in the control than in the intervention group. Conclusion: The routine placement of an NPA can reduce the frequency of hypoxemic events during endoscopic sedation with minor risks for nasopharyngeal injury.

A prediction model for hypoxemia during routine sedation for gastrointestinal endoscopy

“…In addition, increasing the concentration of inspired oxygen and performing chin lift maneuvers and jaw thrusts are simple, effective strategies to prevent hypoxemia. Furthermore, routine use of the nasopharyngeal airway during general anesthesia in this subgroup of patients might reduce the frequency of hypoxemic events during endoscopic sedation 1 . Ultimately, Cohen suggested that an ideal short-acting sedative agent such as propofol, without adjunctive agents such as opioids or benzodiazepines, would be most appropriate for high-risk patients 23 .…”

“…Drug-induced sedation in endoscopic procedures improves patient comfort and facilitates endoscopic performance 1 . Propofol-mediated sedation has become increasingly popular during endoscopic procedures because of its rapid onset of action and short duration of effect 2 .…”

“…It may result in lethal hypoxemia requiring emergency airway management and risks interrupting or ending the endoscopic procedure. Some of the approaches that are helpful in alleviating hypoxemia include increasing supplemental oxygen, inserting a nasopharyngeal airway, performing various airway maneuvers such as chin lifting, providing positive pressure ventilation, and achieving an open airway via endotracheal intubation 1 , 5 . Early identification of high-risk patients prior to endoscopy may help the physician select patients who would benefit most from an aggressive intervention.…”

Considerable Variability of Procedural Sedation and Analgesia Practices for Gastrointestinal Endoscopic Procedures in Europe

“…Apart from the endoscopist, a well-trained sedation professional should be responsible for clinical and instrumental monitoring of the patient during GI endoscopy, as recommended at the International Sedation Endoscopy Workshop in 2009 [ 19 - 21 ]. In Europe in particular the debate on propofol-based sedation is strongly influenced by different legislation between countries and reimbursement matters and unfortunately not always by quality arguments [ 22 ].…”

Propofol-Based Sedation in Gastrointestinal Endoscopy: Getting Safer and Safer

“…This could be proven by the analysis of a prospective complication registry of 388,404 gastrointestinal endoscopic procedures in the typical NAAP manner [11,12]. In this context the study by Müller et al [13] should be seen.…”