From the Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.
Department of Anesthesiology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia, China.
Anesth Analg. 2022 Mar 1;134(3):615-623. doi: 10.1213/ANE.0000000000005828.
Hypoxemia can occur during gastroscopy under intravenous anesthesia. The aim of this randomized controlled trial was to evaluate whether oxygenation using a nasal mask can reduce the incidence of hypoxemia during gastroscopy under intravenous anesthesia compared with a traditional nasal cannula.
A total of 574 patients scheduled for gastroscopy under intravenous anesthesia were enrolled and randomly assigned to receive either a nasal mask or a traditional nasal cannula for oxygenation. The primary outcome was the incidence of hypoxemia. The secondary outcomes included the incidence of severe hypoxemia, duration of hypoxemia, minimum oxygen saturation, the proportion of emergency airway management, length of procedure, recovery time, and the satisfaction of the anesthetist and gastroenterologists as well as other adverse events (including cough, hiccups, nausea and vomiting, reflux, aspiration, and laryngospasm).
A total of 565 patients were included in the analysis: 282 patients in the nasal cannula group and 283 patients in the nasal mask group. The incidence of hypoxemia was lower in the nasal mask group (18.0%) than in the nasal cannula group (27.7%; relative risk [RR] = 0.65; 95% confidence interval [CI], 0.48-0.89; P = .006), and the hypoxemia lasted a median of 18.0 seconds (interquartile range, 10.0-38.8) in the nasal mask group and 32.5 seconds (20.0-53.5) in the nasal cannula group (median difference -14.50; 95% CI, -22.82 to -1.34; P = .047). The proportion of patients requiring emergency airway management was significantly lower in the nasal mask group (8.8%) than in the nasal cannula group (19.1%; RR, 0.46; 95% CI, 0.30-0.73; P < .001). No difference was found in the overall incidence of other adverse events between the 2 groups (nasal mask 20.8%; nasal cannula 17.0%; RR, 1.23; 95% CI, 0.87-1.73; P = .25). Satisfaction was higher with the nasal mask than with the nasal cannula from the perspective of anesthetists (96.1% for nasal mask versus 84.4% for nasal cannula; RR, 1.14; 95% CI, 1.08-1.20; P < .001) and gastroenterologists (95.4% for mask versus 81.9% for cannula; RR, 1.17; 95% CI, 1.10-1.24; P < .001). There were no significant differences in the incidence of severe hypoxemia, minimum oxygen saturation, length of procedure, or recovery time between the 2 groups.
Nasal mask oxygenation reduced the incidence of hypoxemia during anesthesia for gastroscopy under intravenous anesthesia.
在静脉麻醉下进行胃镜检查时可能会发生低氧血症。本随机对照试验的目的是评估与传统鼻导管相比，使用鼻罩供氧是否可以降低静脉麻醉下胃镜检查时低氧血症的发生率。
共纳入 574 例拟行静脉麻醉下胃镜检查的患者，并随机分配接受鼻罩或传统鼻导管吸氧。主要结局是低氧血症的发生率。次要结局包括严重低氧血症的发生率、低氧血症持续时间、最低氧饱和度、紧急气道管理的比例、手术时间、恢复时间、麻醉师和胃肠病学家的满意度以及其他不良事件（包括咳嗽、呃逆、恶心和呕吐、反流、误吸和喉痉挛）。
共纳入 565 例患者进行分析：鼻导管组 282 例，鼻罩组 283 例。鼻罩组低氧血症发生率（18.0%）低于鼻导管组（27.7%；相对风险 [RR] = 0.65；95%置信区间 [CI]，0.48-0.89；P =.006），鼻罩组低氧血症持续时间中位数为 18.0 秒（四分位距，10.0-38.8），鼻导管组为 32.5 秒（20.0-53.5）（中位数差异-14.50；95%CI，-22.82 至-1.34；P =.047）。鼻罩组需要紧急气道管理的患者比例（8.8%）明显低于鼻导管组（19.1%；RR，0.46；95%CI，0.30-0.73；P <.001）。两组其他不良事件的总体发生率无差异（鼻罩组 20.8%；鼻导管组 17.0%；RR，1.23；95%CI，0.87-1.73；P =.25）。从麻醉师（鼻罩 96.1%对鼻导管 84.4%；RR，1.14；95%CI，1.08-1.20；P <.001）和胃肠病学家（鼻罩 95.4%对鼻导管 81.9%；RR，1.17；95%CI，1.10-1.24；P <.001）的角度来看，鼻罩的满意度均高于鼻导管。两组严重低氧血症、最低氧饱和度、手术时间或恢复时间的发生率均无显著差异。
鼻罩供氧可降低静脉麻醉下胃镜检查时低氧血症的发生率。
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