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BALTIMORE -- The SuperNO2VA device allowed for better oxygenation for bariatric patients undergoing pre-bariatric surgery esophagogastroduodenoscopy (EGD), a prospective, observational study found.

Among the group, the median lowest oxygen saturation was higher (100% vs 90.5%, P<0.0001), and the desaturation events were significantly lower (11.5% vs 46.7%, P=0.004) when compared with a control group who received conventional nasal cannula, according to Francesa Dimou, of Weill Cornell Medical College in New York City, and colleagues.

Between the two groups, there was no difference in length of procedure time, time spent in the post-anesthesia care unit, and the postprocedural oxygen saturations, Dimou said at the Society of American Gastrointestinal and Endoscopic Surgeons meeting.

There was a case of hypoxia that warranted overnight admission, and that was the only complication, Dimou added.

For patients having bariatric surgery, preoperative EGD is becoming more common, and patients with morbid obesity present a unique challenge for clinicians. Obstructive sleep apnea (OSA) and obesity are independent risk factors for hypoxemia during endoscopy, Dimou noted.

"The current standard of care regarding sedation for patients undergoing endoscopy utilizes devices such as nasal cannula or oxygen face mask. However, especially with oxygen face mask, the issues that we have is that we don't have access to the oral cavity in able to do intraoral procedures. The other option is positive pressure ventilation, and this can alleviate hypoxemia. However, again this limits the use of intraoral procedures including EGD," Dimou said.

The is a sealed nasal positive airway pressure mask designed to deliver high fraction inhaled oxygen and titratable positive pressure, the authors explained.

Dimou's group evaluated 26 SuperNO2VA patients (median age 38.5) and 30 control group patients (median age 42.5). Patients in the SuperNO2VA cohort were more likely to have OSA (53.9% vs 26.7%, P=0.04), be in a greater ASA class (P=0.03), and have a greater BMI (47.4 vs. 40.5, P<0.0001) versus controls. Demographic information was gathered via chart review.

Airway intervention and sedative dosing for both groups were selected by the anesthesia team. For the SuperNO2VA group, positive pressure was employed as needed and the mask was placed securely over the patients nose as high flow oxygen was delivered to the patient.

"Although not all outcomes reached statistical significance, utility of such a device may optimize care in a challenging population and also mitigate the risks of hypoventilation in the morbidly obese," Dimou emphasized.

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