Nasal continuous positive pressure versus simple face mask oxygenation for adult obese and obstructive sleep apnea patients undergoing colonoscopy under propofol-based general anesthesia without tracheal intubation: A randomized controlled trial
Institution:
1. Department of Anesthesiology, Hospital Bernardino Rivadavia, Universidad de Buenos Aires, Buenos Aires, Argentina;2. Department of Anesthesiology and Perioperative Medicine, The University of Texas – MD Anderson Cancer Center, Houston, TX, USA;3. Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas – MD Anderson Cancer Center, Houston, TX, USA;4. Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA;1. Tufts Medical Center, Department of Anesthesiology, 800 Washington Street, Boston, MA 02111, United States of America;2. Northwell Health, Department of Anesthesiology, 2000 Marcus Avenue, New Hyde Park, NY 11042, United States of America;3. University of Oklahoma Health Sciences Center, Department of Anesthesiology, WP 1140 920 Stanton L Young Blvd, Oklahoma City, OK 73104, United States of America;1. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America;2. Department of Quantitative Health Sciences, Cleveland Clinic, OH, United States of America;3. Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, United States of America;1. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States of America;2. Department of Anesthesiology, Department of Orthopaedics and Rehabilitation (by courtesy), Department of Surgery (by courtesy), University of Vermont Larner College of Medicine, Burlington, VT, United States of America;3. Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, United States of America;4. Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America;5. Department of Anesthesiology, Winter Haven Hospital, Winter Haven, FL, United States of America;6. Department of Anesthesiology, Moffitt Cancer Center, University of South Florida, Tampa, FL, United States of America;1. Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA;2. Perioperative Outcomes and Informatics Collaborative (POIC), Winston-Salem, NC, USA;4. Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA;5. Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH and Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA;6. Center for Nursing Research, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA;7. Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA;8. Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC, USA;9. Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA;10. Center for Biomedical Informatics, Wake Forest University School of Medicine, Winston-Salem, NC, USA;11. Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA;12. Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, NC, USA;13. Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA
Abstract:
Study objectiveTo determine if a nasal positive airway pressure (nasal CPAP) mask would decrease the number of hypoxemic events in obese and obstructive sleep apnea patients undergoing colonoscopy.DesignSingle-center prospective randomized controlled trial.SettingTertiary academic center.PatientsWe enrolled 109 patients with diagnosis of obesity and/or obstructive sleep apnea scheduled to undergo colonoscopy under propofol general anesthesia without planned tracheal intubation.InterventionPatients were randomly allocated (1:1 ratio) to receive supplementary oxygen at a flow of 10 L/min, either through a nasal CPAP or a simple facemask.MeasurementsThe primary endpoint was the difference in the mean percentage of time spent with oxygen saturation below 90% between the two groups. Secondary outcomes included the need for airway maneuvers/interventions, average SpO2 during the case, duration and severity of oxygen desaturation, incidence and duration of procedural interruptions, and satisfaction and tolerance scores.Main results54 were allocated to the simple face mask and 55 to the nasal CPAP mask arms, respectively. A total of 6 patients experienced a hypoxemic event. Among these patients, the difference in the percentage of time spent with oxygen saturation below 90% was not clinically relevant (p = 1.0). However, patients in the nasal CPAP group required less chin lift (20% vs. 42.6%; p = 0.01) and oral cannula insertion (12.7% vs.29.6%; p = 0.03). The percentage of patients with at least one airway maneuver was higher in the simple face mask arm (68.5% vs. 41.8%; p = 0.005). Patient tolerance to device score was lower in the nasal CPAP group (8.85 vs. 9.56; p = 0.003).ConclusionsA nasal CPAP did not prevent hypoxemia and should not be used routinely for colonoscopy in obese or OSA patients if a simple face mask is an alternative therapy. However, potential advantages of its use include fewer airway maneuvers or interventions, which may be desirable in certain clinical settings.Trial registrationClinicaltrials.gov, identifier: NCT05175573.
