Comparative efficacy of modified nasopharyngeal airway and nasal cannula for oxygenation in deeply sedated patients undergoing endoscopic retrograde cholangiopancreatography: a randomized controlled trial

Abstract

Background: Hypoxemia frequently occurs during deeply sedated endoscopic retrograde cholangiopancreatography (ERCP). Modified nasopharyngeal airway (mNPA) is a nasopharyngeal cannula with a ventilation adapter connected to an anesthesia circuit for respiratory support. This single-blind, two-group, randomized controlled trial aimed to evaluate the efficacy and safety of mNPA relative to nasal cannula (NC) in patients undergoing ERCP sedation. Methods: Adult participants scheduled for elective ERCP under sedation were randomly assigned in a 1:1 ratio to receive either mNPA or NC for oxygen supply. Both groups were administered 1.5 to 2.0 mg/kg intravenous propofol and 5 to 10 µg sufentanil. The primary outcome was hypoxemia (SpO2 < 90%) and the secondary outcome was the incidence of recurrent hypoxemia (≥ 2 episodes of SpO₂ <90%). Other sedation-related adverse events (SRAEs) and side effects (including nose bleeding and drying, mouth drying, sore throat, abdominal pain, nausea and vomiting, and chills, etc.) during recovery were also assessed. Results: In total, 596 patients were enrolled without dropouts or missing data. Those receiving mNPA (N = 295) had a significantly lower incidence of hypoxemia than those receiving NC oxygen supply (N = 301; 7.1% vs. 13.6%, P = 0.009). The incidence of SpO2-related interruptions was also significantly lower in the mNPA group than in the NC group (6.8% vs. 13%, P = 0.012). While differences in SRAEs were generally not statistically significant between the groups, there was a noteworthy increase in nasal bleeding in the mNPA group (6.8% vs. 1%, P < 0.001). Conclusions: The utilization of mNPA for oxygen delivery during ERCP sedation led to a marked decrease in hypoxemia incidence and associated procedural disruptions. These finding offer valuable insights for airway management during deep sedation for ERCP anesthesia management and warrant consideration in clinical practice. Trial registration: Chictr.org.cn ChiCTR2300075730 (date of registration: September 14, 2023).