Incidence and predictors of airway obstruction during high-flow nasal oxygen assisted procedural sedation during gastrointestinal interventions: A prospective observational study

• Published in: Journal of clinical anesthesia Vol. 89; p. 111160
• Main Authors: Fitzgerald, Nicholas, Thiruvenkatarajan, Venkatesan, Brown-Beresford, Kate, Liu, Wai-Man, Gupta, Drishti, Van Wijk, Roelof M., Ludbrook, Guy L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2023; Elsevier Limited
• Subjects: Airway management; Airway obstruction; Anesthesia; Body mass index; Colonoscopy; Deep sedation; Endoscopy; Fentanyl; Gender; Multivariate analysis; Observational studies; Obstructive sleep apnoea; Oxygen inhalation therapy; Sleep apnea; Oxygen inhalation therapy; Obstructive sleep apnoea; Deep sedation; Endoscopy; Airway obstruction; Colonoscopy
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2023.111160

[...]in the multivariate analysis, only underlying OSA was noted to be the significant predicting factor for airway obstruction albeit with wide confidence intervals [OR: 3.48; 95% CI: 1.76–6.89; p < 0.01; Table 2]. [...]peri-procedural airway obstruction was likely in one in three patients who underwent gastrointestinal interventions with HFNO supplementation in our study. Variables Univariate analysis Multivariate analysis Odds Ratio 95% CI p-value Odds Ratio 95% CI p-value Gender (Female) 0.97 0.58–1.61 0.90 1.20 0.69–2.10 0.52 Age < 50 0.53 0.25–1.11 0.09 0.82 0.32–2.11 0.68 50–70 1.55 0.92–2.62 0.10 1.64 0.85–3.17 0.14 > 70 0.89 0.50–1.59 0.69 – – – BMI (> 30 kg/m2) 1.75 1.03–2.99 0.04 1.17 0.63–2.16 0.61 Smoker (Yes vs No) 0.84 0.51–1.41 0.51 0.77 0.44–1.33 0.34 OSA (Yes vs No) 3.39 1.88–6.11 0.00 3.48 1.76–6.89 <0.01 Procedure Colonoscopy (vs endoscopy or both or others) 0.85 0.50–1.43 0.53 0.81 0.46–1.42 0.46 Mode of Sedation TCI (vs Intermittent bolus) 0.88 0.52–1.47 0.62 0.93 0.51–1.68 0.80 Fentanyl Used (Yes vs No) 1.06 0.60–1.87 0.85 1.29 0.63–2.64 0.49 Fentanyl dose >1 μg/kg 0.82 0.31–2.17 0.68 0.94 0.29–3.08 0.92 Midazolam Used (Yes vs No) 1.32 0.60–2.91 0.49 1.05 0.42–2.58 0.92 Table 2 Univariate and multivariate analysis of the predictors of airway obstruction.