Oxygen delivery with high risk hypoxemia esophagogastroduodenoscopy

Abstract

<p>An EGD is considered a reduced airway access case due to patient positioning and the insertion of an endoscope. The endoscope can contribute to airway obstruction, and it prevents the anesthetist from using a mask for oxygen delivery. Therefore, oxygen is typically administered via SNC with EtCO2 monitoring capability. This form of oxygen administration limits the maximum deliverable FiO2 to 0.4 because SNCs can only effectively deliver 4-6 L/min of oxygen. Propofol, benzodiazepines, and occasionally opioids are commonly administered sedatives during these procedures, all of which are respiratory depressants. The combination of these factors poses a risk of hypoxemia, especially for patients who are already at risk of hypoxemia due to preexisting conditions. To combat this there are alternative airway devices available for endoscopic procedures, one such being a hi-flow nasal cannula (HFNC). The benefits of using a HFNC are that it can deliver oxygen at a rate of up to 60 L/min with titratable FiO2 from 0.21-1.0. Additionally, the increased flow rate creates positive pressure that can help reduce upper airway obstruction.</p>