Recent Developments in Devices Used for Gastrointestinal Endoscopy Sedation

Abstract

Hypoxemia is a frequent and potentially fatal complication occurring in patients during gastrointestinal endoscopy. The administration of propofol sedation increases the risk of most complications, especially hypoxemia. Nevertheless, propofol has been increasingly used in the United States, and the trend is likely to increase in the years to come. Patient satisfaction and endoscopist satisfaction along with rapid turnover are some of the touted reasons for this trend. However, propofol sedation generally implies deep sedation or general anesthesia. As a result, hypopnea and apnea frequently occur. Inadequate sedation and presence of irritable airway often cause coughing and laryngospasm, both leading to hypoxemia and potential cardiac arrest. Hence, prevention of hypoxemia is of paramount importance. Traditionally, standard nasal cannula is used to administer supplement oxygen. However, it cannot sufficiently provide continuous positive airway pressure (CPAP) or positive pressure ventilation. Device manufacturers have stepped in to fill this void and created many types of cannulas that provide apneic insufflation of oxygen and CPAP and eliminate dead space. Such measures decrease the incidence of hypoxemia. This review aimed to provide essential information of some of these devices. Clin Endosc 2021 Mar 18.

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“… 15 Finally, supraglottic airway devices such as nasopharyngeal tubes, laryngeal tubes, and laryngeal masks are being evaluated during GI endoscopy, often with modifications to the original device to accommodate endoscopy during upper GI endoscopy. 16 However, these devices are invasive and require specialized training.…”

An intravenous anesthetic drug-propofol, influences the biological characteristics of malignant tumors and reshapes the tumor microenvironment: A narrative literature review

“…In recent years, with the continuous development of endoscopic techniques and the increased demand for painless endoscopy, propofol is also being used for various outpatient endoscopic surgeries such as painless gastrointestinal endoscopy and tracheoscopy. Propofol is becoming increasingly popular in sedation for gastrointestinal endoscopy due to its unique pharmacokinetic properties, predictable recovery process and rapid recovery (Goudra et al, 2021).…”

Should We Use High-Flow Nasal Cannula in Patients Receiving Gastrointestinal Endoscopies? Critical Appraisals through Updated Meta-Analyses with Multiple Methodologies and Depiction of Certainty of Evidence

“…Conventional oxygen therapies (COT), such as low-flow nasal cannula, modified face mask, and nasopharyngeal airway, have been used to prevent hypoxemia during endoscopic sedation [6]. Nevertheless, the capability to provide a high fraction of inspired oxygen concentrations (FiO 2 ) through those devices is limited because their low-flow rates may not meet patients' peak inspiration flow, resulting in oxygen mixing with carbon dioxide (CO 2 ) in the dead space.…”