Comparison of disposable anesthetic nasal mask and nasal cannula in elderly patients undergoing intravenous anesthesia for gastroscopy: a randomized controlled clinical trial

Abstract

Abstract Background Elderly patients are prone to hypoxemia when they undergo gastroscopy under intravenous anesthesia due to their decreased physiological oxygen reserve capacity, increased sensitivity to drugs, etc. This study aimed to assess whether oxygen administration with the disposable anaesthetic nasal mask can lessen the incidence of hypoxemia in elderly patients during gastroscopy under intravenous anesthesia in comparison to a traditional nasal cannula. Methods A total of 300 patients were randomly assigned to oxygen administration by traditional double-chamber nasal cannula or disposable anesthetic nasal mask(n = 150 each). Primary outcome measures were the incidence of hypoxemia and severe hypoxemia. Secondary outcome measures included the duration of hypoxemia, lowest intraoperative SpO2, the proportion of individuals who needed emergency airway management, the proportion of individuals discontinuing gastroscopy, the duration of operation, recovery time from anesthesia, the total dose of propofol, satisfaction of endoscopist, anaesthesiologist and patient, other adverse events. Results Compare with the nasal cannula group, the incidence of hypoxemia was significantly reduced (15.5% vs. 45.0%; P < 0.001), the lowest intraoperative SpO2 was significantly increased (96.9% vs. 92.4%, P < 0.001), and the proportion of patients requiring emergency airway management was significantly reduced (13.5% vs. 37.6%; P < 0.001) in the anesthetic nasal mask group. There was only one patient (0.7%) requiring emergency suspension of endoscopy in the anesthetic nasal mask group, while there were 29 patients (19.5%; P < 0.001) requiring emergency suspension of endoscopy in the nasal cannula group. The satisfaction of the endoscopist, as well as anaesthesiologist in the anaesthetic nasal mask group, was significantly higher than in the nasal cannula group (P < 0.01). No major variations were observed in the incidence of severe hypoxemia, hypoxemia duration, duration of endoscopy, recovery time from anesthesia, the total dose of propofol, intraoperative adverse events, patient satisfaction, etc., between the two groups. Conclusion The use of an anesthetic nasal mask reduces the occurrence of hypoxemia during gastroscopy under intravenous anesthesia in elderly patients. Trial registration: ChiCTR2100053388, 20/11/2021.