Use of high-flow nasal cannula in obese patients receiving colonoscopy under intravenous propofol sedation: A case series

Chi Chan Lee, Osman Perez, Faryal I Farooqi, Trupti Akella, Sameer Shaharyar, Melissa Elizee, Chi Chan Lee, Osman Perez, Faryal I Farooqi, Trupti Akella, Sameer Shaharyar, Melissa Elizee

Abstract

Intravenous sedation during colonoscopy has become the standard practice in the United States given its higher patient satisfaction and procedural quality. This practice is not free of side effects as a significant proportion of patients undergoing this procedure tend to have respiratory depression and desaturation events. Obesity, as it relates to higher levels of body mass index (BMI) has a positive correlation with the incidence of hypoxemia. During colonoscopy High flow nasal cannula (HFNC) may potentially improve oxygen performance in patients receiving colonoscopy under intravenous sedation. Here we present 3 cases of patients undergoing adjunctive oxygen therapy with HFNC during colonoscopy with intravenous sedation. We found patients to have lower number of desaturation events and were satisfied with their experience.

Keywords: Colonoscopy; HFNC (high-flow nasal cannula); High BMI (body mass index); Intravenous sedation; Obesity.

References

    1. Singh H., Poluha W., Cheung M., Choptain N., Baron K.I., Taback S.P. Propofol for sedation during colonoscopy. Cochrane Database Syst. Rev. 2008;(4)
    1. Bannert C., Reinhart K., Dunkler D., Trauner M., Renner F., Knoflach P. Sedation in screening colonoscopy: impact on quality indicators and complications. Am. J. Gastroenterol. 2012;107(12)
    1. Beitz A., Riphaus A., Meining A., Kronshage T., Geist C., Wagenpfeil S. Capnographic monitoring reduces the incidence of arterial oxygen desaturation and hypoxemia during propofol sedation for colonoscopy: a randomized, controlled study (ColoCap Study) Am. J. Gastroenterol. 2012;107(8)
    1. Wani S., Azar R., Hovis C.E., Hovis R.M., Cote G.A., Hall M. Obesity as a risk factor for sedation related complications during propofol mediated sedation for advanced endoscopic procedures. Gastrointest. Endosc. 2011;74(6)
    1. Groves N., Tobin A. High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust. Crit. Care. 2007;20(4):12631.
    1. Dysart K., Miller T.L., Wolfson M.R., Shaffer T.H. Research in high flow therapy: mechanisms of action. Respir. Med. 2009;103(10):14005.
    1. Spoletini G., Alotaibi M., Blasi F., Hill N.S. Heated humidified high flow nasal oxygen in adults: mechanisms of action and clinical implications. Chest. 2015;148(1):25361.
    1. Parke R., McGuinness S., Eccleston M. Nasal high flow therapy delivers low level positive airway pressure. Br. J. Anaesth. 2009;103(6):886–890. aep280.
    1. Lomas C., Roca O., Álvarez A., Masclans J.R. Fibroscopy in patients with hypoxemic respiratory insufficiency: utility of the highflow nasal cannula. Respir. Med. CME. 2009;2(3):1214.
    1. Triantafillidis J.K., Merikas E., Nikolakis D., Papalois A.E. Sedation in gastrointestinal endoscopy: current issues. World J. Gastroenterol. 2013;19.4:463–481.
    1. Petrini J.L., Egan J.V., Hahn W.V. Unsedated colonoscopy: patient characteristics and satisfaction in a community-based endoscopy unit. Gastrointest. Endosc. 2009;69(3 Pt 1):567–572.
    1. Rex D.K., Imperiale T.F., Portish V. Patients willing to try colonoscopy without sedation: associated clinical factors and results of a randomized controlled trial. Gastrointest. Endosc. 1999;49:554–559.
    1. Heuss Ludwig T. Safety of propofol for conscious sedation during endoscopic procedures in high-risk patients–a prospective, controlled study. Am. J. Gastroenterol. 2003;98.8:1751–1757.
    1. Tyler M., Sirish S., Sheila R. A prospective assessment of sedation-related adverse events and patient and endoscopist satisfaction in ERCP with anesthesiologist-administered sedation. Gastrointest. Endosc. 2011;73.4:710–717.
    1. Lightdale J.R., Goldman D.A., Feldman H.A., Newburg A.R., DiNardo J.A., Fox V.L. Microstream capnography improves patient monitoring during moderate sedation: a randomized, controlled trial. Pediatrics. 2006;117.6:e1170–e1178.
    1. Qadeer M.A., Vargo J.J., Dumot J.A., Lopez R., Trolli P.A., Stevens T. Capnographic monitoring of respiratory activity improves safety of sedation for endoscopic cholangiopancreatography and ultrasonography. Gastroenterology. 2009;136.5:1568–1576.
    1. Ritchie J.E., Williams A.B., Gerard C., Hockey H. Evaluation of a humidified nasal high-flow oxygen system, using oxygraphy, capnography and measurement of upper airway pressures. Anaesth. Intensive Care. 2011;39.6:1103.
    1. Groves Nicole, Tobin Antony. High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust. Crit. Care. 2007;20.4:126–131.
    1. Lucangelo U., Vassallo F.G., Marras E., Ferluga M., Beziza E., Comuzzi L. High-flow nasal interface improves oxygenation in patients undergoing bronchoscopy. Critical Care Res. Pract. 2012;2012
    1. Sago Teppei, Harano N., Chogyoji Y., Nunomaki M., Shiiba S., Watanabe S. A nasal high-flow system prevents hypoxia in dental patients under intravenous sedation. J. Oral Maxillofac. Surg. 2015;73.6:1058–1064.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe