Effect of anesthetic nasal mask on hypoxemia in elderly patients undergoing gastroscopy with deep sedation: a randomized controlled trial

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BACKGROUND: The risk of hypoxemia is increased in elderly patients who are sedated during gastroscopy. This can be attributed to the physiological changes associated with aging, such as reduced oxygen reserves and an increased sensitivity to sedatives. This study aimed to evaluate whether an anesthetic nasal mask is more effective than a traditional nasal cannula at preventing hypoxemia during gastroscopy in elderly patients. METHODS: 300 participants were randomly allocated into traditional nasal cannula group or anesthetic nasal mask group (150 patients in each group). Deep sedation was achieved with intravenous propofol, titrated to maintain spontaneous breathing. The primary outcome was the incidence of hypoxemia (defined as SpO₂ ≤ 92%). Secondary outcomes included the incidence of severe hypoxemia (defined as an intraoperative SpO₂ of ≤ 75% at any time or a hypoxemia duration of ≥ 60 s), duration of hypoxemia, minimum intraoperative SpO₂, incidence of emergency airway interventions, incidence of gastroscopy interruption, procedure duration, recovery time, total propofol dose, satisfaction scores from endoscopists, anesthesiologists and patients, and other adverse events. RESULTS: Compared with traditional nasal cannulas, using an anaesthetic nasal mask could significantly reduce the incidence of hypoxemia (45.0% vs. 15.5%, p < 0.001). It also increased the minimum intraoperative SpO₂ (from 94.0% to 99.0%; P < 0.001) and reduced the need for jaw thrust (from 37.6% to 13.5%; P < 0.001). Satisfaction levels among endoscopists and anesthesiologists were significantly greater in the anesthetic nasal mask group (P < 0.01). However, there were no significant differences between the two groups in terms of the incidence of severe hypoxemia. CONCLUSIONS: Elderly patients undergoing gastroscopy with deep sedation experienced a significant reduction in the incidence of hypoxemia when anesthetic nasal masks were used. TRIAL REGISTRATION: The trial was registered with the Chinese Clinical Trial Registry ( https://www.chictr.org.cn , ChiCTR2100053388, registered on 20/11/2021).

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