Prevention of Hypoxaemia During Upper-Gastrointestinal Endoscopy by Means of Oxygen via Nasal Cannulae

Bell, G. D.; Morden, A.; Bown, Stephen G.; Coady, T.; Logan, R. F. A.

doi:10.1016/s0140-6736(87)92282-3

Cited by 139 publications

(63 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patients lay supine on the x ray tat start of the procedure to allow baseline ments and application of nasal cann were then turned to the left lateral pos the throat sprayed with lignocaine metered dose spray (7 Nalbuphine (Nubain, Dupont Pharmaceuticals Ltd), followed by midazolam (Hypnovel, Roche Products Ltd) was given through an indwelling intravenous cannula until satisfactory sedation was achieved and the duodenoscope (Olympus JFT10I/TJF10) was then introduced. Patients were turned prone once the endoscope was positioned in the duodenum.…”

mentioning

confidence: 99%

Oxygen saturation during endoscopic retrograde cholangiopancreatography: a comparison of two protocols of oxygen administration.

Rigg

Watt

Tweedle

et al. 1994

Gut

View full text Add to dashboard Cite

Patients having endoscopic retrograde cholangiopancreatography (ERCP) are generally elderly and require sedation while in the prone position. These factors may be expected to aggravate any risk of arterial hypoxia. This study evaluated two protocols of oxygen administration, one with and one without pre-oxygenation. In 25 patients in whom preoxygenation with 4 litres/minute for five minutes before sedation was used, followed by continuous oxygen administration, arterial oxygen saturation did not fail below 90% at any stage during the procedure. By contrast, in 25 patients who were not pre-oxygenated oxygen saturation fell below 90% in nine (36%). As expected, hypoxia occurred most frequently during the early stages of sedation and endoscope insertion. Hypoxia did not occur in association with operations such as sphincterotomy, stone extraction or stent insertion. This study confirms that arterial hypoxia is a common event during ERCP and can be completely prevented by pre-oxygenation with four litres of oxygen given intranasally for five minutes before sedation.

show abstract

mentioning

confidence: 99%

Oxygen saturation during endoscopic retrograde cholangiopancreatography: a comparison of two protocols of oxygen administration.

Rigg

Watt

Tweedle

et al. 1994

Gut

View full text Add to dashboard Cite

show abstract

“…We have previously shown that supplementary oxygen via nasal cannulae is an effective way of preventing hypoxaemia during endoscopy (Bell et al, 1987c) Changes in ventilation (Table 2) The baseline minute volume of the patients given diazepam (mean 8.1 (3.4) 1 min-') was lower than that of the patients given midazolam (mean 9.0 (3.5) 1 min'-) but the difference was not significant at the 5% level. After intravenous sedation minute volume fell a mean of 2.61 with the fall being almost identical after each drug.…”

Section: Methodsmentioning

confidence: 91%

A comparison of diazepam and midazolam as endoscopy premedication assessing changes in ventilation and oxygen saturation.

Bell

Morden

Coady

et al. 1988

Brit J Clinical Pharma

Self Cite

View full text Add to dashboard Cite

1 One hundred and two consecutive patients undergoing upper gastrointestinal endoscopy were randomised to be sedated with either intravenous diazepam (Diazemuls-Kabi Vitrum) or intravenous midazolam (Hypnovel-Roche). It was assumed that midazolam was likely to be approximately twice as potent as diazepam on the basis of previous work. 2 All patients had an ear oximeter attached throughout the procedure to record continuously their level of oxygen saturation. 3 All 102 patients had pre-endoscopy respiratory function tests measured and 100 wore an induction plethysmograph vest to allow continuous estimation of respiratory rate and excursion. The plethysmograph was calibrated using a pneumotachygraph, so baseline, post-injection and post-endoscopy minute volumes could be estimated. 4 The age, sex ratio and pre-endoscopy respiratory function tests of the 51 patients given intravenous diazepam in a mean dose (s.d.) of 11.5 (5.8) mg over a mean of 3.4 (0.9) min) were similar to that of the 51 patients sedated with intravenous midazolam (mean dose 6.0 (2.8) mg over 3.3 (0.9) min. 5 Both drugs significantly reduced minute volume (P < 0.001) and oxygen saturation (P < 0.001). Midazolam appeared to produce slightly greater hypoxaemia with 57% having falls in oxygen saturation of greater than 2.5% compared with only 35% given an equivalent dose of diazepam. 6 Ventilation was still less than baseline when re-checked some minutes after removal of the gastroscope. The speed of recovery appeared faster after diazepam sedation which is in contrast to its longer pharmacological half-life. 7 Potentially dangerous falls in oxygen saturation were observed in five cases (three following diazepam and two midazolam), necessitating supplementary oxygen administration. The implications of these findings are discussed.

show abstract

“…Although monitorization with electronic devices improves patient assessment, it should not replace clinical control (5). A pulse oximetry may improve control of the respiratory function in patients under sedation and analgesia (13,14). Besides, the administration of oxygen before and during endoscopy reduces desaturation (12).…”

Section: Discussionmentioning

confidence: 99%

“…Aunque la monitorización mediante equipos electrónicos mejora la valoración del paciente, no debe en ningún caso sustituir al control clínico (5). Un pulsioxímetro mejora el control de la función respiratoria en pacientes bajo sedación y analgesia (13,14). Así mismo, la administración de oxígeno suplementario antes y durante la endoscopia disminuye la magnitud de la desaturación (12).…”

Section: Discussionunclassified

Sedation at Endoscopic Units in Galicia: results of the "Sociedad Gallega de Patología Digestiva" inquiry

Cubiella

Seco

Piudo

et al. 2005

Rev. esp. enferm. dig.

View full text Add to dashboard Cite

Aim: to evaluate the human and material resources available for sedation, and the usual manner of handling them at endoscopic units in Galicia.Methods: a prospective and descriptive study based on the performance, distribution, and analysis of a clinical practice inquiry. We requested information about endoscopies performed, available means for sedation, sedation monitoring, and level of sedation used in each procedure.Results: our inquiry was answered by twenty endoscopic units (thirteen were in public hospitals, and eleven performed complex procedures). Of these units, 80% had a pulse oximeter, 42% had continuous electrocardiography, 40% had a defibrillator, and 45% had a recovery area. The drug most commonly used in gastroscopies was midazolam (76%), and the combination midazolammeperidine was most frequent in both colonoscopies (72%) and ERCPs (60%). An anesthesiologist was usually available for certain procedures in 15% of units, and as an exception in 65%. Of those inquired, 35% wished to have a full-time anesthesiologist in the unit, 25% wished to have an anesthetist only for certain procedures, and 35% on an exceptional basis. Finally, endoscopists considered that 83% of therapeutical gastroscopies, 87% of therapeutical colonoscopies, 98% of ERCPs, 95% of enteroscopies, and 98% of echoendoscopies deserved sedation.Conclusions: although endoscopists consider that endoscopic procedures should benefit from sedation in a high proportion, the available resources to safely monitor patients are inadequate in some units.

show abstract

Prevention of Hypoxaemia During Upper-Gastrointestinal Endoscopy by Means of Oxygen via Nasal Cannulae

Cited by 139 publications

References 20 publications

Oxygen saturation during endoscopic retrograde cholangiopancreatography: a comparison of two protocols of oxygen administration.

Oxygen saturation during endoscopic retrograde cholangiopancreatography: a comparison of two protocols of oxygen administration.

A comparison of diazepam and midazolam as endoscopy premedication assessing changes in ventilation and oxygen saturation.

Sedation at Endoscopic Units in Galicia: results of the "Sociedad Gallega de Patología Digestiva" inquiry

Contact Info

Product

Resources

About