title: High-flow nasal oxygen availability for sedation decreases the use of general anesthesia during endoscopic retrograde cholangiopancreatography and endoscopic ultrasound.
abstract: OBJECTIVE
  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 GAvsdeep 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 GAvssedation cases respectively.
  
  
  RESULTS
  During the study period 238 ERCP or EUS cases were identified for analysis. Statistical testing was employed and aP< 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).
  
  
  CONCLUSIONS
  High-flow nasal oxygen availability was associated with decreased GA utilization and improved oxygenation for ERCP and EUS during sedation.
authors.affiliation: Roman Schumann, Robert M Knapp, Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA 02111, United States.
authors.forename: Roman
authors.initials: R
authors.lastname: Schumann
authors.affiliation: Roman Schumann, Robert M Knapp, Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA 02111, United States.
authors.forename: Nikola S
authors.initials: NS
authors.lastname: Natov
authors.affiliation: Roman Schumann, Robert M Knapp, Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA 02111, United States.
authors.forename: Klifford A
authors.initials: KA
authors.lastname: Rocuts-Martinez
authors.affiliation: Roman Schumann, Robert M Knapp, Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA 02111, United States.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Finkelman
authors.affiliation: Roman Schumann, Robert M Knapp, Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA 02111, United States.
authors.forename: Tom V
authors.initials: TV
authors.lastname: Phan
authors.affiliation: Roman Schumann, Robert M Knapp, Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA 02111, United States.
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Hegde
authors.affiliation: Roman Schumann, Robert M Knapp, Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA 02111, United States.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Knapp
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects / Q000706:statistics & numerical data*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D054810:Deep Sedation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D019160:Endosonography; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol
keywords: Anesthesia; Endoscopic retrograde cholangiopancreatography; Endoscopic ultrasound; Endoscopy; High flow nasal oxygen; Oxygenation; Sedation