Hypoxemia during outpatient gastrointestinal endoscopy: The effects of sedation and supplemental oxygen

Abstract

Study Objectives: To compare the effects on oxygen saturation as measured by pulse oximetry (SpO 2) and ECG changes of endoscopy alone, sedation followed by endoscopy, and sedation followed by endoscopy with supplemental oxygen (O 2) during upper gastrointestinal (GI) endoscopy. Study Design: Randomized trial. Setting: Outpatient gastroenterology clinic at a university medical center. Patients: 58 healthy patients scheduled for outpatient upper GI endoscopy, with no clinical evidence of respiratory disease. Interventions: Patients were randomly allocated to three groups: Group 1 received no benzodiazepines before endoscopy and breathed room air throughout (n = 18), Group 2 received midazolam intravenously (IV) before endoscopy and breathed room air throughout (n = 20), and Group 3 received IV midazolam and 2 L/min O 2 through nasal cannulae during endoscopy (Group 3; n = 20). Measurements and Main Results: Data collection, which included heart rate, cardiac rhythm, and SpO 2 were recorded at seven intervals: baseline, topical anesthesia of the oropharynx, mouth gag insertion, endoscope insertion, biopsy, endoscope removal, and five minutes postendoscopy. In Group 2, mean SpO 2 decreased after midazolam was administered and remained depressed during endoscopy ( p < 0.05). After midazolam was given, Group 2 patients differed significantly from patients in Groups 1 and 3 ( p < 0.05). Conclusions: The use of hypnotic doses of benzodiazepines is the primary factor responsible for the reduced oxygenation seen during endoscopy. Neither the presence of the endoscope alone nor the use of midazolam with supplemental O 2 caused a decreased oxygenation. This study also suggests that the routine use of benzodiazepines is unnecessary when the endoscopy is of short duration, and the endoscopist employs good topicalization of the oropharynx. In patients who require sedation for endoscopy, O 2 administration prevents hypoxemia.