Clinical Trials Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2021; 9(20): 5479-5489
Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5479
Prospective, randomized comparison of two supplemental oxygen methods during gastroscopy with propofol mono-sedation in obese patients
Liu-Jia-Zi Shao, Fang-Xiao Hong, Fu-Kun Liu, Lei Wan, Fu-Shan Xue
Liu-Jia-Zi Shao, Fang-Xiao Hong, Fu-Kun Liu, Lei Wan, Fu-Shan Xue, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Shao LJZ and Hong FX contributed equally to this study; Shao LJZ, Hong FX and Xue FS contributed to the study design, planning, and implementation, and wrote the manuscript; Shao LJZ and Hong FX analyzed the data; Wan L and Liu FK contributed to study implementation, data analysis, and revision of the manuscript.
Supported by “Renfu” Research Fund by Chinese Society of Digestive Endoscopy, No. CSDE022020090001.
Institutional review board statement: This study was approved by the Ethics Committee of Beijing Friendship Hospital, China (Ethics Committee number: 2017-P2-009-02).
Clinical trial registration statement: The trial protocol has been registered with the Chinese Clinical Trial Registry (registration number: ChiCTR-IOR-17013089).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None of the authors has any financial or other potential conflicts of interest related to this work.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fu-Shan Xue, MD, Professor, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, Beijing 100050, China. fushanxue@outlook.com
Received: March 16, 2021
Peer-review started: March 16, 2021
First decision: May 1, 2021
Revised: May 7, 2021
Accepted: May 19, 2021
Article in press: May 19, 2021
Published online: July 16, 2021
Abstract
BACKGROUND

Hypoxemia is a common complication in obese patients during gastroscopy with sedation. The Wei nasal jet tube (WNJT) is a new special nasopharyngeal airway with the ability to provide supraglottic jet ventilation and oxygen insufflation via its built-in wall channels. The aim of this study was to compare the efficacy and safety of the WNJT vs a nasal cannula for supplemental oxygen during gastroscopy with propofol mono-sedation in obese patients.

AIM

To compare the efficacy and safety of the WNJT vs a nasal cannula for supplemental oxygen during gastroscopy with propofol mono-sedation in obese patients.

METHODS

A total of 103 obese patients with a body mass index of 30 kg/m2 or more undergoing elective gastroscopy under propofol mono-sedation were randomly assigned to receive supplemental oxygen at 5 L/min through either a WNJT (WNJT group, n = 51) or a nasal cannula (nasal cannula group, n = 52). The lowest pulse oxygen saturation (SpO2) and mild and severe hypoxemia during gastroscopy were recorded. The primary outcome was the incidence of hypoxemia.

RESULTS

The lowest SpO2 during gastroscopy with propofol mono-sedation was significantly increased in the WNJT group compared with the nasal cannula group. The incidence of mild hypoxemia and total incidence of hypoxemia were significantly lower in the WNJT group than in the nasal cannula group. Other than a higher incidence of epistaxis in the WNJT group, the occurrence of adverse events was similar between the devices. While neither device demonstrated a statistically significant difference in satisfaction among patients, the WNJT did result in improved satisfaction among anesthetists and physicians.

CONCLUSION

During gastroscopy with propofol mono-sedation in obese patients, the WNJT, when compared with a nasal cannula for supplemental oxygen, can significantly reduce the occurrence of hypoxemia and improve both arterial oxygenation and satisfaction among anesthetists and physicians. The use of the WNJT may, however, lead to epistaxis in a few patients. In view of this clinically acceptable risk-benefit ratio, the WNJT may be recommended as an alternative tool for supplemental oxygen for the prevention of hypoxemia during gastroscopy with propofol mono-sedation in obese patients.

Keywords: Supplemental oxygen, Gastroscopy, Sedation, Obese patients

Core Tip: This study is a prospective, randomized controlled trial aimed to compare the efficacy and safety of Wei nasal jet tube (WNJT) and nasal prongs for supplemental oxygen during gastroscopy with propofol monosedation in obese patients when a moderate oxygen flow is used. Our results show that the WNJT compared with the nasal prongs for supplemental oxygen is more effective for prevention of hypoxemia during gastroscopy with propofol mono-sedation, though it may result in a potential risk of epistaxis in few patients.