Department of Anaesthesiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
Department of Anaesthesiology, Pudong New Area People's Hospital, Shanghai 201200, China.
Br J Anaesth. 2017 Jul 1;119(1):158-166. doi: 10.1093/bja/aex091.
Hypoventilation is the main reason for hypoxia during upper gastrointestinal endoscopy procedures with sedation. The key to preventing hypoxia is to maintain normal ventilation during the procedure. We introduced supraglottic jet oxygenation and ventilation (SJOV) through a new Wei nasal jet tube (WNJ) to reduce the incidence of hypoxia in patients sedated with propofol during upper gastrointestinal endoscopy procedures.
In a multicentre, prospective randomized single-blinded study, 1781 outpatients undergoing routine upper gastrointestinal endoscopy who were sedated with propofol by an anaesthetist were randomized into the following three groups: the supplementary oxygen via nasal cannula group [nasal cannula oxygen: O 2 (2 litres min -1 ) was administered via a nasal cannula]; the supplementary oxygen via WNJ group [WNJ oxygen: O 2 (2 litres min -1 ) was administered through a WNJ]; and the SJOV via WNJ group (WNJ SJOV: SJOV was administered via WNJ) at three centres from March 2015 to July 2016. The primary outcome of interest was the incidence of hypoxia (peripheral oxygen saturation of 75-89%). Other adverse events were also recorded.
Supraglottic jet oxygenation and ventilation decreased the incidence of hypoxia from 9 to 3% ( P <0.0001). No severe hypoxia occurred in the WNJ SJOV group, one instance occurred in the WNJ oxygen group, and two instances were observed in the nasal cannula oxygen supply control group. Supraglottic jet oxygenation and ventilation-related minor adverse events increased significantly within 1 min after the procedure but decreased 30 min later.
The use of SJOV during upper gastrointestinal endoscopy for patients who are sedated with propofol reduces the incidence of hypoxia, with minor and tolerable adverse events. Supraglottic jet oxygenation and ventilation has a favourable risk-to-benefit ratio and may improve patient safety.
NCT02436018.
在镇静状态下进行上消化道内镜检查时，低通气是导致缺氧的主要原因。预防缺氧的关键是在手术过程中保持正常通气。我们通过一种新的韦氏鼻喷气管（WNJ）引入了经声门上喷射氧气通气（SJOV），以降低接受异丙酚镇静的上消化道内镜检查患者的缺氧发生率。
在一项多中心、前瞻性、随机、单盲研究中，将 1781 名接受常规上消化道内镜检查的门诊患者，由麻醉师给予异丙酚镇静，随机分为三组：鼻导管吸氧组（经鼻导管给予氧气：2 升/分钟）；WNJ 吸氧组（WNJ 氧气：通过 WNJ 给予氧气：2 升/分钟）；和 WNJ SJOV 组（WNJ SJOV：通过 WNJ 给予 SJOV）。该研究于 2015 年 3 月至 2016 年 7 月在三个中心进行。主要观察终点为缺氧发生率（外周血氧饱和度 75-89%）。还记录了其他不良事件。
声门上喷射氧气通气降低了缺氧发生率，从 9%降至 3%（P<0.0001）。WNJ SJOV 组无严重缺氧发生，WNJ 氧气组有 1 例，鼻导管供氧对照组有 2 例。声门上喷射氧气通气相关的轻微不良事件在操作后 1 分钟内显著增加，但 30 分钟后减少。
在接受异丙酚镇静的上消化道内镜检查中使用 SJOV 可降低缺氧发生率，不良事件轻微且可耐受。声门上喷射氧气通气具有有利的风险效益比，可提高患者安全性。
NCT02436018。
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