Supraglottic jet oxygenation and ventilation for obese patients under intravenous anesthesia during hysteroscopy: a randomized controlled clinical trial

Abstract

Background Supraglottic jet oxygenation and ventilation (SJOV) can effectively maintain adequate oxygenation in patients with respiratory depression, even in apnea patients. However, there have been no randomized controlled clinical trials of SJOV in obese patients. This study investigated the efficacy and safety of SJOV using WEI Nasal Jet tube (WNJ) for obese patients who underwent hysteroscopy under intravenous anesthesia without endotracheal intubation. Methods A single-center, prospective, randomized controlled study was conducted. The obese patients receiving hysteroscopy under intravenous anesthesia were randomly divided into three groups: Control group maintaining oxygen supply via face masks (100% oxygen, flow at 6 L/min), the WNJ Oxygen Group with WNJ (100% oxygen, flow: 6 L/min) and the WNJ SJOV Group with SJOV via WNJ [Jet ventilator working parameters:100% oxygen supply, driving pressure (DP) 0.1 MPa, respiratory rate; (RR): 15 bpm, I/E; ratio 1:1.5]. SpO 2 , P ET CO 2 , BP, HR, ECG and BIS were continuously monitored during anesthesia. Two-Diameter Method was deployed to measure cross sectional area of the gastric antrum (CSA-GA) by ultrasound before and after SJOV in the WNJ SJOV Group. Episodes of SpO 2 less than 95%, P ET CO 2 less than 10 mmHg, depth of WNJ placement and measured CSA-GA before and after jet ventilation in the WNJ SJOV Group during the operation were recorded. The other adverse events were collected as well. Results A total of 102 patients were enrolled, with two patients excluded. Demographic characteristics were similar among the three groups. Compared with the Control Group, the incidence of P ET CO 2 < 10 mmHg, SpO 2 < 95% in the WNJ SJOV group dropped from 36 to 9% ( P = 0.009),from 33 to 6% ( P = 0.006) respectively,and the application rate of jaw-lift decreased from 33 to 3% ( P = 0.001), and the total percentage of adverse events decreased from 36 to 12% ( P = 0.004). Compared with the WNJ Oxygen Group, the use of SJOV via WNJ significantly decreased episodes of SpO 2 < 95% from 27 to 6% ( P = 0.023), P ET CO 2 < 10 mmHg from 33 to 9% ( P = 0.017), respectively. Depth of WNJ placement was about 12.34 cm in WNJ SJOV Group. There was no significantly difference of CSA-GA before and after SJOV in the WNJ SJOV Group ( P = 0.234). There were no obvious cases of nasal bleeding in all the three groups. Conclusions SJOV can effectively and safely maintain adequate oxygenati...

High frequency jet ventilation through mask contribute to oxygen therapy in patients undergoing bronchoscopic intervention under deep sedation

“…In this research, the incidence of adverse events was lower than previous reported 10,20 . Among the 150 patients, only 7 patients developed intra-operative hypoxemia, which was relatively short and the oxygenation was effectively improved after treatment.…”

“…Supraglottic jet ventilation (SJV) was also superior toconventional means of oxygen delivery in obese patients under intravenous anesthesia 10 . However, it is unclear whether jet ventilation is superior to COT in maintaining intra-operative oxygenation in patientswith airway stenosis during BI under deep sedation.…”

High frequency jet ventilation through mask contribute to oxygen therapy among patients undergoing bronchoscopic intervention under deep sedation

“…In this research, the incidence of adverse events was lower than that previous reported [10,20]. Among the 150 patients, only seven developed intra-operative hypoxemia, which was relatively short and the oxygenation was effectively improved after treatment.…”

“…High-ow oxygen through nasal cannula or mask was used among patients infected with COVID-19 associated with severe hypoxemia, and it showed reductions in the need for therapeutic escalation and intubation among patients who received high-ow oxygen [9]. Supraglottic jet ventilation (SJV) was also superior to conventional means of oxygen delivery among patients with obesity who were under intravenous anesthesia [10]. However, whether jet ventilation is superior to COT in maintaining intra-operative oxygenation is unclear among patients with airway stenosis during BI under deep sedation.…”

High frequency jet ventilation through mask contributes to oxygen therapy among patients undergoing bronchoscopic intervention under deep sedation

“…High-flow oxygen through nasal cannula or mask was used among patients infected with COVID-19 associated with severe hypoxemia, and it showed reductions in the need for therapeutic escalation and intubation among patients who received high-flow oxygen [ 9 ]. Supraglottic jet ventilation (SJV) is also superior to conventional means of oxygen delivery among patients with obesity who are under intravenous anesthesia [ 10 ].…”