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October 14, 2012
1:00:00 PM - 4:00:00 PM
Room Hall C-Area H
Is No-Cost TSE Mask More Efficient than High Nasal Cannula Oxygen Flow in Reducing Severe Desaturation in Patients Under Deep Propofol Sedation During Upper GI Endoscopy?
James T. Tse, M.D.,Ph.D., Shaul Cohen, M.D., Branson Collins, M.D., John Denny, M.D., Sylviana Barsoum, M.D., Laurie Spina, M.D., Kristen Dauphinee, M.D., May Fernandez, M.D., Melissa S. Wu, M.D., Christine W. Hunter, M.D.
UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
Introduction: Patients undergoing upper GI endoscopy (EGD) routinely receive IV sedation and nasal cannula (NC) O2. NC O2 reservoir is lost when the mouth is kept open with a bite-block. Deep sedation may cause respiratory depression and severe desaturation (Desat). NC O2 flow may be raised in an attempt to improve oxygenation. In severe cases, assisted bag-mask ventilation is needed. A plastic sheet was shown to improve oxygenation by transforming NC to a face tent (TSE “Mask”) in sedated patients during EGD1. We compared its use and high NC O2 flow in reducing severe Desat during EGD.

Methods: Review of patients who underwent EGD, EUS, PEG or ERCP identified 2 groups. G1 (NC, n=64) received only NC O2. G2 (TM, n=171) received NC O2 and a TSE “Mask” using a clean plastic sheet to cover patient's eyes, nose and mouth (Photo)1-3. Patients received NC O2 (3-5 l/min or higher) and only IV propofol. NC patients were separated according to NC O2 flow into NC1 (3-5 l/min) and NC2 (6-10 l/min). Student t-test and Chi Square test were used for analysis. A p value <0.05 was considered as significant. (Mean±S.D.)

Results: There were no differences in age (NC1: 60±18 yrs; NC2: 64±16; TM: 60±14), BMI (NC1: 27±4 kg/m2; NC1: 27±5 ; TM: 27±7), ASA Status (NC1: 2.2±0.6; NC2: 2.2±0.8; TM:2.3±0.7), room air O2 Sat (NC1: 98±2%; NC2: 97±2%; TM:97±2%), propofol dose (NC1: 201±71 mcg/kg/min; NC2: 184±73 ; TM:182±63) and duration (NC1: 34±13 min; NC2: 37±19 ; TM:40±17).

There were significant differences in highest NC O2 flow (NC1: 3.6±0.7 l/min; NC2: 7.0±1.5; TM: 4.8±1.2) and O2 Sat after 5 min pre-oxygenation (NC1: 99±2%; NC2: 99±1%; TM: 100±1%), lowest O2 Sat (NC1: 90±11%; NC2: 84±12%; TM: 97±4%) (Fig 1), severe Desat (O2 Sat≤85%) (NC1: 9/37; NC2: 15/27; TM: 3/171) (Fig 2) and bag-mask ventilation (NC1: 3/37; NC2: 6/27 ; TM: 1/171).

Ten NC1 patients had severe Desat (O2 Sat: 79±13%). Eight NC1 patients’ NCs were converted to TMs. O2 Sat was improved to 97±3%, 98±2% and 99±1% at 5 min intervals. Two NC1 patients received assisted bag-mask ventilation and NCs were then converted to TMs.

Eighteen NC2 patients had severe Desat (O2 Sat: 79±11%). Twelve NC2 patients’ NCs were converted to TMs. O2 Sat was improved to 94±7%, 97±4% and 99±2% at 5 min intervals. Six NC2 patients received assisted ventilation and NCs were then converted to TMs.

TM patients had higher FeO2 (0.72±0.16) than CN1 (0.52±0.12) and CN2 (0.42±0.2).

Conclusion: Data show that TSE “Mask” is more efficient than high NC O2 flow in reducing severe desaturation and bag-mask ventilation in patients under deep propofol sedation during EGD. This face tent takes a few seconds to prepare at no cost and may improve patient safety. Although it can be used as a rescue device when patient’s oxygenation deteriorates, it should be routinely used prior to sedation during EGD.

Ref: 1. Anesth 107:A922, 2007; 2. Anesth 102:484, 2005; 3. www.TSEMask
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