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Randomized trial of a novel double lumen nasopharyngeal catheter versus traditional nasal cannula during total intravenous anesthesia for gastrointestinal procedures.
J Clin Anesth. 2017 May; 38:52-56.JC

Abstract

STUDY OBJECTIVE

Patients undergoing general anesthesia routinely experience episodes of hypoxemia. There are multiple causes of procedural oxygen desaturation including upper airway obstruction and central hypoventilation. We hypothesize that oxygen supplementation via nasopharyngeal catheter (NPC) will decrease the number of episodes of hypoxemia as compared to traditional NC oxygen supplementation in patients undergoing general anesthesia provided by an anesthesia provider for gastrointestinal endoscopy procedures.

DESIGN

Randomized control trial.

SETTING

Endoscopy suite.

PATIENTS

Sixty patients undergoing intravenous general anesthesia for endoscopic gastrointestinal procedures that did not require endotracheal intubation were enrolled.

INTERVENTIONS

Patients were randomized to receive supplemental oxygen by either a standard nasal cannula or a nasopharyngeal catheter. Initial oxygen flow rate was 4l/min and titrated at the anesthesia provider's discretion. Intravenous anesthetic consisted of a propofol infusion.

MEASUREMENTS

Hypoxemia was defined as a pulse oximetry reading of <92%. Secondary outcomes included number of airway assist maneuvers such as jaw lift or other airway interventions.

MAIN RESULTS

Of the 60 enrolled patients; three subjects in the NPC group were excluded from further analysis. There was no difference between group in age, ASA classification, Body Mass Index, oropharyngeal classification or total propofol dose. Patients who received nasopharyngeal oxygen supplementation were less likely to experience a clinically significant oxygen desaturation event 3 of 27 (11.0%) versus 12 of 30 subjects (40.0%), p=0.013. Interventions to assists with airway management were required for fewer patients in the NPC group 4 (14.8%) versus the NC group, 17 (56.7%), p=0.001.

CONCLUSION

Oxygen supplementation via a nasopharyngeal catheter during intravenous general anesthesia resulted in significantly fewer episodes of hypoxemia and number of airway assist maneuvers. Future studies are needed to assess the utility of NPC in other clinical environments where supplemental oxygen is required in the setting of potential airway obstruction.

Authors+Show Affiliations

Department of Anesthesiology and Critical Care, Vanderbilt University Medical Center, 1211 21st Ave South, Suite 526 MAB, Nashville, TN 37232, USA. Electronic address: adam.b.king@vanderbilt.edu.Department of Anesthesiology and Critical Care, Vanderbilt University Medical Center, 1211 21st Ave South, Suite 526 MAB, Nashville, TN 37232, USA. Electronic address: bret.d.alvis@vanderbilt.edu.Department of Anesthesiology, Division of Multi-Specialty, Vanderbilt University Medical Center, 1301 Medical Center Drive, 4648 TVC, Nashville, TN 37232-5614, USA. Electronic address: douglas.hester@vanderbilt.edu.Department of Anesthesiology, Perioperative Clinical Research Institute, Vanderbilt University Medical Center, 1211 Medical Center Drive, MAB 504, Nashville, TN 37232; USA. Electronic address: susan.taylor@vanderbilt.edu.Department of Anesthesiology, Division of Multi-Specialty, Vanderbilt University Medical Center, 1301 Medical Center Drive, 4648 TVC, Nashville, TN 37232-5614, USA. Electronic address: mike.higgins@vanderbilt.edu.

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

28372678

Citation

King, Adam B., et al. "Randomized Trial of a Novel Double Lumen Nasopharyngeal Catheter Versus Traditional Nasal Cannula During Total Intravenous Anesthesia for Gastrointestinal Procedures." Journal of Clinical Anesthesia, vol. 38, 2017, pp. 52-56.
King AB, Alvis BD, Hester D, et al. Randomized trial of a novel double lumen nasopharyngeal catheter versus traditional nasal cannula during total intravenous anesthesia for gastrointestinal procedures. J Clin Anesth. 2017;38:52-56.
King, A. B., Alvis, B. D., Hester, D., Taylor, S., & Higgins, M. (2017). Randomized trial of a novel double lumen nasopharyngeal catheter versus traditional nasal cannula during total intravenous anesthesia for gastrointestinal procedures. Journal of Clinical Anesthesia, 38, 52-56. https://doi.org/10.1016/j.jclinane.2017.01.025
King AB, et al. Randomized Trial of a Novel Double Lumen Nasopharyngeal Catheter Versus Traditional Nasal Cannula During Total Intravenous Anesthesia for Gastrointestinal Procedures. J Clin Anesth. 2017;38:52-56. PubMed PMID: 28372678.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomized trial of a novel double lumen nasopharyngeal catheter versus traditional nasal cannula during total intravenous anesthesia for gastrointestinal procedures. AU - King,Adam B, AU - Alvis,Bret D, AU - Hester,Douglas, AU - Taylor,Susan, AU - Higgins,Michael, Y1 - 2017/01/22/ PY - 2016/04/18/received PY - 2017/01/09/revised PY - 2017/01/14/accepted PY - 2017/4/5/entrez PY - 2017/4/5/pubmed PY - 2017/9/15/medline KW - Ambulatory anesthesia KW - Endoscopy KW - Nasal cannula KW - Nasopharyngeal catheter SP - 52 EP - 56 JF - Journal of clinical anesthesia JO - J Clin Anesth VL - 38 N2 - STUDY OBJECTIVE: Patients undergoing general anesthesia routinely experience episodes of hypoxemia. There are multiple causes of procedural oxygen desaturation including upper airway obstruction and central hypoventilation. We hypothesize that oxygen supplementation via nasopharyngeal catheter (NPC) will decrease the number of episodes of hypoxemia as compared to traditional NC oxygen supplementation in patients undergoing general anesthesia provided by an anesthesia provider for gastrointestinal endoscopy procedures. DESIGN: Randomized control trial. SETTING: Endoscopy suite. PATIENTS: Sixty patients undergoing intravenous general anesthesia for endoscopic gastrointestinal procedures that did not require endotracheal intubation were enrolled. INTERVENTIONS: Patients were randomized to receive supplemental oxygen by either a standard nasal cannula or a nasopharyngeal catheter. Initial oxygen flow rate was 4l/min and titrated at the anesthesia provider's discretion. Intravenous anesthetic consisted of a propofol infusion. MEASUREMENTS: Hypoxemia was defined as a pulse oximetry reading of <92%. Secondary outcomes included number of airway assist maneuvers such as jaw lift or other airway interventions. MAIN RESULTS: Of the 60 enrolled patients; three subjects in the NPC group were excluded from further analysis. There was no difference between group in age, ASA classification, Body Mass Index, oropharyngeal classification or total propofol dose. Patients who received nasopharyngeal oxygen supplementation were less likely to experience a clinically significant oxygen desaturation event 3 of 27 (11.0%) versus 12 of 30 subjects (40.0%), p=0.013. Interventions to assists with airway management were required for fewer patients in the NPC group 4 (14.8%) versus the NC group, 17 (56.7%), p=0.001. CONCLUSION: Oxygen supplementation via a nasopharyngeal catheter during intravenous general anesthesia resulted in significantly fewer episodes of hypoxemia and number of airway assist maneuvers. Future studies are needed to assess the utility of NPC in other clinical environments where supplemental oxygen is required in the setting of potential airway obstruction. SN - 1873-4529 UR - https://www.unboundmedicine.com/medline/citation/28372678/Randomized_trial_of_a_novel_double_lumen_nasopharyngeal_catheter_versus_traditional_nasal_cannula_during_total_intravenous_anesthesia_for_gastrointestinal_procedures_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0952-8180(17)30050-8 DB - PRIME DP - Unbound Medicine ER -