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Nasal positive pressure with the SuperNO2VA™ device decreases sedation-related hypoxemia during pre-bariatric surgery EGD

  • 2019 SAGES Oral
  • Published:
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Abstract

Introduction

Pre-operative esophagogastroduodenoscopy (EGD) is becoming routine practice in patients undergoing bariatric surgery. Many patients with morbid obesity have obstructive sleep apnea (OSA), which can worsen hypoxia during an EGD. In this study, we report our outcomes using the SuperNO2VA™ device, a sealed nasal positive airway pressure mask designed to deliver high-fraction inhaled oxygen and titratable positive pressure compared to conventional nasal cannula.

Methods

Between June 2016 and August 2017, we conducted a prospective observational study that included 56 consecutive patients who presented for EGD prior to bariatric surgery. Airway management was done using either the SuperNO2VA™ (N = 26) device or conventional nasal cannula (N = 30). Patient demographics, procedure details, and outcomes were compared between the two groups.

Results

The SuperNO2VA™ group had a lower median age compared to the control group (38.5 vs. 48.5 years, p = 0.04). These patients had a higher body mass index (BMI) (47.4 vs. 40.5, IQR, p < 0.0001), higher ASA class (p = 0.03), and were more likely to have OSA (53.9% vs. 26.7%, p = 0.04). Desaturation events were significantly lower in the SuperNO2VA™ group (11.5% vs. 46.7%, p = 0.004) and the median lowest oxygen saturation was higher in the SuperNO2VA™ group (100% vs. 90.5%, p < 0.0001).

Discussion

This is the first study to report on the use of the SuperNO2VA™ device in bariatric patients undergoing pre-operative screening EGD. The use of the SuperNO2VA™ device offers a clinical advantage compared to the current standard of care. Our data demonstrate that patients with higher BMI, higher ASA classification, and OSA were more likely to have the SuperNO2VA™ device used; yet, paradoxically, these patients were less likely to have issues with desaturation events. Use of this device can optimize care in this challenging patient population by minimizing the risks of hypoventilation.

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Authors and Affiliations

  1. Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medicine, 525 East 68th Street Box 294, New York, NY, 10065, USA

    Francesca Dimou, Samantha Huynh, Gregory Dakin, Alfons Pomp, Zachary Turnbull, Jon D. Samuels & Cheguevara Afaneh

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  1. Francesca Dimou
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  2. Samantha Huynh
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  3. Gregory Dakin
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  4. Alfons Pomp
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  5. Zachary Turnbull
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  6. Jon D. Samuels
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  7. Cheguevara Afaneh
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Correspondence to Cheguevara Afaneh.

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Disclosures

Drs. Dimou, Dakin, Turnbull, Pomp, Samuels, Afaneh, and Ms. Huynh have no conflicts of interest or financial ties to disclose.

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Dimou, F., Huynh, S., Dakin, G. et al. Nasal positive pressure with the SuperNO2VA™ device decreases sedation-related hypoxemia during pre-bariatric surgery EGD. Surg Endosc 33, 3828–3832 (2019). https://doi.org/10.1007/s00464-019-06721-1

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  • DOI: https://doi.org/10.1007/s00464-019-06721-1

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