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

Abstract

AIMTo 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.METHODSIn 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.RESULTSDuring 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).CONCLUSIONHigh-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.

The use of high‐flow nasal oxygen during airway management in a child with epidermolysis bullosa dystrophica and a difficult airway

“…Since the introduction of trans‐nasal humidified rapid‐insufflation ventilatory exchange (THRIVE) , there has been a rapid expansion in the peri‐operatively use of HFNO, ranging from apnoeic oxygenation (THRIVE) to procedural sedation and the management of difficult airways . The role of HFNO in paediatric anaesthesia is emerging, showing a promising role in providing apnoeic oxygenation and managing patients with abnormal airways .…”

A potential method for obtaining wave-form capnography during high flow nasal oxygen

“…Its use in anaesthesia is rapidly increasing, providing an alternative to low flow oxygen devices during sedation for procedures such as bronchoscopy and gastroenterology as well as a potential role in non-invasive cardiological, radiological, emergency medicine and persistent pain procedures. [1][2][3] The main advantages of heated and humidified HFNO are improved maintenance of adequate oxygenation with less drying of the upper airway mucosa, thereby improving patient comfort. However, one outstanding question is the role of wave-form capnography during patient sedation when HFNO is administered.…”

High-flow nasal cannula versus standard oxygen therapy assisting sedation during endoscopic retrograde cholangiopancreatography in high risk cases (OTHER): study protocol of a randomised multicentric trial

“…These advantages include the ability to create PEEP (up to 5-7.5 cm H20), reduce the work of breathing, provide constant FIO2 up to 100%, provide good humidification, and aid washout of the pharyngeal dead space [19,20]. In one centre, introducing the option to use HFNC affected anaesthetic practice and decreased the usage of general anaesthesia with an endotracheal tube (for a mixed group of ERCP and endobronchial ultrasound procedures) [21]. This observational study also showed HFNC also decreased the anaesthesia only time.…”