High-flow nasal oxygen availability for sedation decreases the use of general anesthesia during endoscopic retrograde cholangiopancreatography and endoscopic ultrasound.
AIM
To examine whether high-flow nasal oxygen (HFNO) availability influences the use of general anesthesia (GA) in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) and associated outcomes.


METHODS
In this retrospective study, patients were stratified into 3 eras between October 1, 2013 and June 30, 2014 based on HFNO availability for deep sedation at the time of their endoscopy. During the first and last 3-mo eras (era 1 and 3), no HFNO was available, whereas it was an option during the second 3-mo era (era 2). The primary outcome was the percent utilization of GA vs deep sedation in each period. Secondary outcomes included oxygen saturation nadir during sedation between periods, as well as procedure duration, and anesthesia-only time between periods and for GA vs sedation cases respectively.


RESULTS
During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and a P < 0.050 was significant unless the Bonferroni correction for multiple comparisons was used. General anesthesia use was significantly lower in era 2 compared to era 1 with the same trend between era 2 and 3 (P = 0.012 and 0.045 respectively). The oxygen saturation nadir during sedation was significantly higher in era 2 compared to era 3 (P < 0.001) but not between eras 1 and 2 (P = 0.028) or 1 and 3 (P = 0.069). The procedure time within each era was significantly longer under GA compared to deep sedation (P ≤ 0.007) as was the anesthesia-only time (P ≤ 0.001).


CONCLUSION
High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.
['Schumann|Roman|R|', 'Natov|Nikola S|NS|', 'Rocuts-Martinez|Klifford A|KA|', 'Finkelman|Matthew D|MD|', 'Phan|Tom V|TV|', 'Hegde|Sanjay R|SR|', 'Knapp|Robert M|RM|']
D000281:Administration, Intranasal D000328:Adult D000368:Aged D000369:Aged, 80 and over D000768:Anesthesia, General D002760:Cholangiopancreatography, Endoscopic Retrograde D054810:Deep Sedation D019160:Endosonography D005260:Female D006801:Humans D006993:Hypnotics and Sedatives D008297:Male D008875:Middle Aged D010102:Oxygen Inhalation Therapy D010818:Practice Patterns, Physicians' D015742:Propofol D012189:Retrospective Studies D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome
Oxygenation Sedation Anesthesia Endoscopic retrograde cholangiopancreatography Endoscopic ultrasound Endoscopy High flow nasal oxygen