High-flow nasal oxygen availability for sedation decreases the use of general anesthesia during endoscopic retrograde cholangiopancreatography and endoscopic ultrasound

Roman Schumann, Nikola S Natov, Klifford A Rocuts-Martinez, Matthew D Finkelman, Tom V Phan, Sanjay R Hegde, Robert M Knapp, Roman Schumann, Nikola S Natov, Klifford A Rocuts-Martinez, Matthew D Finkelman, Tom V Phan, Sanjay R Hegde, Robert M Knapp

Abstract

Aim: To examine whether high-flow nasal oxygen (HFNO) availability influences the use of general anesthesia (GA) in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) and associated outcomes.

Methods: In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras (era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era (era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.

Results: During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3 (P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3 (P < 0.001) but not between eras 1 and 2 (P = 0.028) or 1 and 3 (P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation (P ≤ 0.007) as was the anesthesia-only time (P ≤ 0.001).

Conclusion: High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.

Keywords: Anesthesia; Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasound; Endoscopy; High flow nasal oxygen; Oxygenation; Sedation.

Conflict of interest statement

Conflict-of-interest statement: None of the authors report a conflict of interest.

Figures

Figure 1
Figure 1
AIRVO™ 2 (Fisher and Paykel Healthcare Limited, Panmure, New Zealand).
Figure 2
Figure 2
Modified nasal prongs.
Figure 3
Figure 3
Use of general anesthesia during eras 1, 2 and 3. During era 2 (HFNO available) significantly less cases were performed under GA compared to era 1, although this difference did not reach statistical significance between eras 2 and 3. HFNO: High-flow nasal oxygen; GA: General anesthesia. aP = 0.012 era 1 vs era 2.

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