Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Anesth. 2024 Oct;38(5):591-599. doi: 10.1007/s00540-024-03352-2. Epub 2024 Jun 2.
Adequate oxygenation and airway management during deep sedation can be challenging. We investigated the effect of high-flow nasal cannula (group HF) and conventional nasal cannula (group CO) during sedation for endoscopic submucosal dissection (ESD).
Patients undergoing ESD with deep sedation were enrolled. The primary outcome was difference in lowest oxygen saturation (SpO) between the groups. Incidence of hypoxia (SpO < 90%), patients with SpO < 95%, hypercapnia, and airway interventions; operator satisfaction; and adverse events were recorded.
Thirty-two patients in each group completed the study. The mean of minimum SpO values was significantly higher in group HF than in group CO (96.8% ± 4.2% vs. 93.3% ± 5.3%, p = 0.005). The incidence of hypoxia was comparable between the groups (4 [12.5%] vs. 6 [18.8%], p = 0.491); however, patients with SpO < 95% were significantly less in group HF (5 [15.6%] vs. 18 [56.3%], p = 0.003). Incidence of hypercapnia was higher in group HF than in group CO (14 [46.7%] vs. 5 [16.7%], p = 0.013). Airway rescue interventions were significantly less common in group HF. Satisfaction of operators and post-procedural complications were comparable between the two groups. In multivariable analysis, group CO and higher body mass index were risk factors for airway managements (odds ratio [95% confidence interval]: 6.204 [1.784-21.575], p = 0.004; 1.337 [1.043-1.715], p = 0.022, respectively).
Compared to conventional nasal cannula, high-flow nasal cannula maintained higher minimum SpO value during deep sedation with propofol-remifentanil for ESD.
Clinical Trial Registry of the Republic of Korea (KCT0006618, https://cris.nih.go.kr ; registered September 29, 2021; principal investigator: Ji Won Choi).
在深度镇静期间，充分氧合和气道管理可能具有挑战性。我们研究了高流量鼻导管（HF 组）和常规鼻导管（CO 组）在镇静下进行内镜黏膜下剥离（ESD）时的效果。
纳入接受深度镇静下 ESD 的患者。主要结局是两组之间最低血氧饱和度（SpO2）的差异。记录低氧血症（SpO2<90%）、SpO2<95%、高碳酸血症和气道干预的发生率；操作者满意度；以及不良事件。
每组 32 名患者完成了研究。HF 组的最低 SpO2 值平均值明显高于 CO 组（96.8%±4.2% vs. 93.3%±5.3%，p=0.005）。两组低氧血症的发生率相当（4[12.5%] vs. 6[18.8%]，p=0.491）；然而，HF 组 SpO2<95%的患者明显较少（5[15.6%] vs. 18[56.3%]，p=0.003）。HF 组高碳酸血症的发生率高于 CO 组（14[46.7%] vs. 5[16.7%]，p=0.013）。气道抢救干预在 HF 组明显较少。两组操作者满意度和术后并发症相当。多变量分析显示，CO 组和较高的体重指数是气道管理的危险因素（比值比[95%置信区间]：6.204[1.784-21.575]，p=0.004；1.337[1.043-1.715]，p=0.022）。
与常规鼻导管相比，高流量鼻导管在丙泊酚-瑞芬太尼镇静下进行 ESD 时维持更高的最低 SpO2 值。
韩国临床试验注册中心（KCT0006618，https://cris.nih.go.kr；注册日期：2021 年 9 月 29 日；主要研究者：Ji Won Choi）。
