A randomized controlled study on nitrous oxide-sedated transnasal endoscopy for high risk patients of intravenous anesthesia

Abstract

Objective The efficacy and safety of nitrous oxide-sedated transnasal gastroscopy for high-risk patients of intravenous anesthesia were evaluated. Methods A total of 157 patients were randomly assigned to the nitrous oxide group （n = 80） and the oxygen group （n = 77 ）. Heart rate, blood oxygen satu ration, blood pressure and electrocardiogram were monitored. Complications in both groups were recorded. Satisfaction degrees of patients and endoscopy physicians were evaluated with a questionnaire and visual analog scale （VAS） score. The questionnaire questions for physicians included the procedure evaluation （steady, ok, unsteady）. Patients＇ questionnaire questions included discomfort （light, moderate, severe）, the patients＇ tolerance （fine, moderate, weak） and the patients＇ willingness to undergo a second procedure. Statistical analysis was performed between the two groups. Results Six of the toal 157 patients were removed be cause of the operation failure （difficulty in access to nasal cavity in 5 patients and nose bleeding in one patient）, 151 patients underwent the transnasal gastroscopy successfully and completed the questionnaires. In experimental group, there were 37 males and 41 females （mean age was 67.7 years, ranging 16-88 years, 7 patients were grade 1 of ASA, 61 were grade 2, and 11 were grade 3）. In the control group, there were 36 males and 37 females （mean age was 67. 9 years, ranging 17-86 years, 6 patients were grade 1 of ASA, 57 were grade 2, and 9 were grade 3）. There was no differences in sex, average age and ASA grade between the two groups （P 〉 0. 05 ）. There was no difference in the mean operation time between the two groups, either （200. 1 s vs 200. 3 s） （P 〉 0.05 ）. There were no significant differences between the two groups in changes of blood oxygen saturation, blood pressure, electrocardiogram and complication rates （P 〉 0.05 ）. Both physicians＇ and patients＇ positive evaluations of the experimental group were more than that of the con- trol （P 〈 0. 05）, while physicians＇ and patients＇ negative evaluations of the experimental group were less than the control （P 〈 0. 05）. VAS of physicians＇ satisfaction in the experimental group was higher than that of the control group （84 vs 70, t = 14. 67, P 〈0.05）, and VAS of patients＇ satisfaction in the experimental group was superior to the control group （82 vs 71, t = 11.56, P 〈0.05）. The number of patients willing to undergo a second procedure in the experimental group was higher than that of the control （89. 7% vs 69. 9%, P 〈 0.05）. Conclusion Nitrous oxide-sedated transnasat endoscopy is an effective and safe procedure for high risk patients of intravenous anesthesia. Key words: Nitrous oxide-sedated; Transnasal endoscopy