Efficacy of enhanced preoxygenation protocols in mitigating hypoxemia during propofol sedation for gastrointestinal endoscopic procedures: a prospective, randomized, controlled study

Lu, Jun#; Ji, Wentao#; Guo, Yu#; Yang, Shun; Yang, Didi; Li, Bo*; Bo, Lulong*

Author Information

Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China

*Correspondence to: Bo Li, MD, ishilibo@163.com; Lulong Bo, MD, bartbo@smmu.edu.cn.

#These authors contributed equally to this work.

Abstract

Hypoxemia during propofol sedation for gastrointestinal endoscopic procedures is a significant risk and is often exacerbated by inadequate preoxygenation. Effective preoxygenation strategies are essential for reducing the incidence of hypoxemia, especially in high-risk patients. This study aimed to evaluate the efficacy of an enhanced preoxygenation protocol for mitigating hypoxemia during propofol sedation during gastroscopy. In a prospective, randomized, controlled design, patients undergoing gastroscopy were assigned to either an intervention group (enhanced preoxygenation) or a nonintervention group (standard care). The intervention protocol involved the administration of eight tidal volume breaths over 1 minute at an oxygen flow rate of 10 L/min via a tight-fitting face mask, with clinical supervision by an endoscopy nurse. The primary outcome was the incidence of hypoxemia, defined as a peripheral oxygen saturation level of less than 90% at any point during the gastroscopy procedure. Compared with the nonintervention group, the intervention group had a significantly lower incidence of hypoxemia. This effect was particularly pronounced in high-risk patients, including elderly individuals and those with elevated body mass indices. No significant adverse events were observed during the procedure. These results suggest that enhanced preoxygenation may effectively alleviate the occurrence of hypoxemia during propofol sedation in gastrointestinal endoscopic procedures. Further research is needed to assess the broader applicability of this approach and explore additional strategies for optimizing preoxygenation in endoscopic procedures.

摘要

在胃肠镜检查的丙泊酚镇静过程中，低氧血症是一项重大风险，而预给氧不足往往会加剧这一风险。有效的预给氧策略对于降低低氧血症的发生率至关重要，尤其是在高风险患者中。本研究旨在评估一种增强预给氧方案在减轻胃镜检查丙泊酚镇静期间低氧血症方面的效果。在这项前瞻性、随机、对照研究中，接受胃镜检查的患者被分配至干预组（增强预给氧）或非干预组（标准护理）。干预方案包括：在内镜护士的临床监督下，通过密封面罩以10升/分钟的氧流量，在一分钟内进行8次潮气量呼吸。主要结局指标是低氧血症的发生率，定义为在胃镜检查过程中任何时间点外周血氧饱和度低于90%。与非干预组相比，干预组的低氧血症发生率显著降低。这种效果在高风险患者（包括老年人和体重指数较高的患者）中尤为明显。研究过程中未观察到显著的不良事件。这些结果表明，增强预给氧可能有效减少胃肠镜检查中丙泊酚镇静期间低氧血症的发生。需要进一步研究来评估这种方法的更广泛适用性，并探索优化内镜检查中预给氧的其他策略。