Comparison of two supplement oxygen methods during gastroscopy with intravenous propofol anesthesia in obese patients: study protocol for a randomized controlled trial

Abstract

BackgroundHypoxemia is a major complication in obese patients undergoing gastrointestinal endoscopy under intravenous anesthesia or sedation due to altered airway anatomy. We design this randomized controlled trial (RCT) to compare efficacy and safety of the Wei nasal jet tube (WNJT) and nasal prongs for supplement oxygen during gastroscopy with intravenous propofol anesthesia in obese patients.MethodsThe study will be a single-center, prospective RCT. A total of 308 obese patients will be recruited and randomly assigned to receive either the WNJT (group A) or nasal prongs (group B). During gastroscopy with intravenous propofol anesthesia, 5 L/min of oxygen will be delivered through the jet port of the WNJT in the group A and via the nasal prongs in the group B. The primary outcome is the incidence of hypoxemia and severe hypoxemia. The secondary outcomes are adverse events during the gastroscopy, postoperative complications, and satisfaction of the anesthetist, physician, and patient.DiscussionThis RCT aims to clarify whether the WNJT can result in reduced incidences of hypoxemia and complications and provide improved satisfaction to the anesthetist, physician, and patient. Thus, it can be determined if the WNJT is a useful tool for supplement oxygen in obese patients undergoing gastroscopy with intravenous propofol anesthesia. The results will provide the evidence for anesthesiologists to make a decision regarding the choice of supplementary oxygen methods in this condition.Trial registrationChinese Clinical Trial, ChiCTR-IOR-17013089. Registered on 23 October 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2994-8) contains supplementary material, which is available to authorized users.

Supraglottic jet oxygenation and ventilation reduces desaturation during bronchoscopy under moderate to deep sedation with propofol and remifentanil

“…Another potential risk of inserting the WNJ or flexible bronchoscope into a nostril is that of nasal bleeding. 21 , 22 , 39 Nasal bleeding occurred in both groups, but there was no significant difference between groups at the end of the procedure. All nasal bleeding stopped after 30 min.…”

“…SJOV with the WNJ has been used effectively in upper gastrointestinal endoscopy in patients under sedation with propofol. 21 , 22 It has also been used in fibreoptic bronchoscopic intubation of paralysed patients with a difficult airway, 23 without severe complications such as barotrauma or severe nose bleeding. 21 – 23 Therefore, we proposed that using SJOV with the WNJ may be appropriate for reducing hypoxaemia during flexible bronchoscopy under moderate to heavy sedation with a combination of propofol, lidocaine and remifentanil.…”

Safety and efficacy of remimazolam tosilate combined with low-dose fentanyl for procedural sedation in obese patients undergoing gastroscopy: study protocol for a single-centre, double-blind, randomised controlled trial

“…Propofol is a lipophilic agent with a higher distribution volume in adipose tissue-rich individuals, resulting in greater potential for drug accumulation in the body and more frequent occurrence of propofol-related adverse events 18–20. Therefore, extra airway protection and adequate preoxygenation must be ensured when administering it to obese patients 21–23…”

“… 18–20 Therefore, extra airway protection and adequate preoxygenation must be ensured when administering it to obese patients. 21–23 …”

WEI nasal jet tube during monitored anaesthesia care for removal of oesophageal foreign body for a patient with fragile cardiopulmonary function

“…It can be connected to an anaesthesia machine directly for oxygen delivery, and it has two channels built inside the tube wall for jet ventilation and the end-tidal pressure of CO 2 monitoring, respectively. [1] Supraglottic jet oxygenation and ventilation (SJOV) using WNJ has been proved to have the ability of enhancing oxygenation during upper gastrointestinal endoscopy in patients sedated with propofol,[2] and has been demonstrated to save patients from a Can't Intubate, Can't Ventilate (CICV) emergent difficult airway, even with failed laryngeal mask airway(LMA). [3] SJOV by WNJ has also been shown to provide sufficient oxygenation/ventilation in a morbidly obese patient with severe respiratory depression.…”