title: A simple, innovative way to reduce rhinitis symptoms after sedation during endoscopy.
abstract: BACKGROUND
  Supplmental oxygen is routinely given via nasal cannula (NC) to patients undergoing moderate sedation for endoscopy. Some patients complain of profuse rhinorrhea and⁄or sneezing after the procedure, which results in additional medical costs and patient dissatisfaction.
  
  
  OBJECTIVE
  To determine the causal relationship between the route of oxygen delivery and troublesome nasal symptoms, and to seek possible solutions.
  
  
  METHODS
  Patients (n=836) were randomly assigned to one of the three following groups: the NC group (n=294), the trimmed NC (TNC) group (n=268) and the nasal mask (NM) group (n=274). All received alfentanil 12.5 μg⁄kg and midazolam 0.06 mg⁄kg, and adjunct propofol for sedation. Supplemental oxygen at a flow rate of 4 L⁄min was used in the NC and TNC groups, and 6 L⁄min in the NM group. The incidence of nasal symptoms and hypoxia were assessed.
  
  
  RESULTS
  The incidence of rhinitis symptoms was significantly higher in the NC group (7.1%) than in the TNC (0.4%) and NM (0%) groups (P<0.001). The incidence of hypoxia was lower in the NC group (3.1%) (P=0.040). All hypoxia events were transient (ie, less than 30 s in duration). On spirometry, the mean value of the lowest saturation of peripheral oxygen was found to be significantly lower in the NM group (96.8%) than in the NC group (97.7%) (P=0.004).
  
  
  CONCLUSIONS
  Trimming the NC or using NMs reduced the incidence of rhinitis symptoms; however, the incidence of hypoxia was higher. Further investigation regarding the efficiency of oxygen supplementation is warranted in the design of novel oxygen delivery devices.
authors.affiliation: Department of Anesthesiology, Koo Foundation, Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Nai-Liang
authors.initials: NL
authors.lastname: Li
authors.forename: Shiang-Chung
authors.initials: SC
authors.lastname: Tseng
authors.forename: Che-Chang
authors.initials: CC
authors.lastname: Hsu
authors.forename: Wei-Ju
authors.initials: WJ
authors.lastname: Lai
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Su
authors.forename: Tsun-I
authors.initials: TI
authors.lastname: Cheng
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Chen
authors.forename: Wen-Ling
authors.initials: WL
authors.lastname: Peng
mesh_terms: D000328:Adult; D057785:Catheters; D016292:Procedural Sedation; D004724:Endoscopy / Q000009:adverse effects*; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008397:Masks; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000517:prevention & control; D012220:Rhinitis / Q000517:prevention & control*
chemical_list: D010100:Oxygen