High-flow nasal oxygen availability for sedation decreases the use of general anesthesia during endoscopic retrograde cholangiopancreatography and endoscopic ultrasound

• Published in: World journal of gastroenterology : WJG Vol. 22; no. 47; pp. 10398 - 10405
• Main Authors: Schumann, Roman, Natov, Nikola S, Rocuts-Martinez, Klifford A, Finkelman, Matthew D, Phan, Tom V, Hegde, Sanjay R, Knapp, Robert M
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 21-12-2016
• Subjects: Administration, Intranasal; Adult; Aged; Aged, 80 and over; Anesthesia, General - adverse effects; Anesthesia, General - utilization; Cholangiopancreatography, Endoscopic Retrograde; Deep Sedation - adverse effects; Deep Sedation - methods; Deep Sedation - utilization; Endosonography; Female; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics and Sedatives - adverse effects; Male; Middle Aged; Oxygen Inhalation Therapy - adverse effects; Oxygen Inhalation Therapy - utilization; Practice Patterns, Physicians; Propofol - administration & dosage; Propofol - adverse effects; Retrospective Studies; Retrospective Study; Risk Factors; Time Factors; Treatment Outcome; Endoscopic retrograde cholangiopancreatography; High flow nasal oxygen; Anesthesia; Endoscopy; Sedation; Oxygenation; Endoscopic ultrasound
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v22.i47.10398

AIM To examine whether high-flow nasal oxygen(HFNO) availability influences the use of general anesthesia(GA) in patients undergoing endoscopic retrograde cholangiopancreatography(ERCP) and endoscopic ultrasound(EUS) and associated outcomes.METHODS In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras(era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era(era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.RESULTS During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3(P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3(P < 0.001) but not between eras 1 and 2(P = 0.028) or 1 and 3(P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation(P ≤ 0.007) as was the anesthesia-only time(P ≤ 0.001).CONCLUSION High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.