Oxygenation before Endoscopic Sedation Reduces the Hypoxic Event during Endoscopy in Elderly Patients: A Randomized Controlled Trial

Abstract

Background: Sedation endoscopy increases patient and examiner satisfaction but involves complications. The most serious complication is hypoxia, the risk factors for which are old age, obesity, and American Society of Anesthesiologists physical status of 3 or greater. However, clear evidence of oxygenation during sedation endoscopy for elderly people is lacking in US, European, and Korean guidelines. Method: This study was conducted for 1 year starting in August 2018 to evaluate whether pre-oxygenation use 1 min before sedation endoscopy could reduce the incidence of hypoxia in patients older than 65 years of age. A total of 70 patients were divided into the non-oxygenated group (n = 35; control group) and oxygen-treated group (n = 35; experimental group) during endoscopy. Result: The incidence of hypoxia was 28 (80%) in the control group versus 0 (0%) in the pre-oxygenated group. Factors related to hypoxia in the non-oxygenated group were a relatively high dose of midazolam and concomitant injection with narcotic analgesics such as pethidine. Conclusion: The incidence of hypoxia during sedation endoscopy is high in patients over 65 years, but oxygenation during endoscopic sedation in elderly people can significantly reduce the incidence of intraprocedural hypoxic events.

2021 Korean Society of Gastrointestinal Endoscopy Clinical Practice Guidelines for Endoscopic Sedation

“…Therefore, the administration of oxygen is essential to prevent hypoxia at all levels of sedation, including moderate and deep sedation. [50][51][52][53][54][55][56][57][58][59][60][61][62] Denitrogenation and preoxygenation are important for the prevention of hypoxia. The general method of oxygen administration during endoscopic sedation is to administer oxygen after administering sedatives.…”

“…Based on some study findings that preoxygenation 1-2 minutes before the procedure can prevent hypoxia in older adults at high risk for hypoxia, preoxygenation can be considered for at-risk group. 60 Question 7. Are assessments of the level of consciousness, pulse oximetry, and noninvasive blood pressure monitoring necessary during endoscopic sedation?…”

“…Although nasal administration of oxygen cannot lead to 100% denitrogenation even with preoxygenation, it can delay the onset of hypoxia. Based on some study findings that preoxygenation 1–2 minutes before the procedure can prevent hypoxia in older adults at high risk for hypoxia, preoxygenation can be considered for at-risk group [ 60 ].…”

2021 Korean Society of Gastrointestinal Endoscopy Clinical Practice Guidelines for Endoscopic Sedation

“…Therefore, the administration of oxygen is essential to prevent hypoxia at all levels of sedation, including moderate and deep sedation. 50 - 62 …”

“…Based on some study findings that preoxygenation 1–2 minutes before the procedure can prevent hypoxia in older adults at high risk for hypoxia, preoxygenation can be considered for at-risk group. 60 …”