Oxygen prevented hypoxia. Yep.

Why wouldn’t you give oxygen prophylactically to someone undergoing procedural sedation? One argument is that this will delay the detection of respiratory depression since a pre-oxygenated patient can be hyponoeic/apnoeic for longer prior to desaturation. This is not an issue for those of us who use non-invasive capnography during sedation.
In this randomized trial of oxygen vs air during ED propofol procedural sedation there was less hypoxia when high-flow supplemental oxygen was added. The authors made the following observations:

  • There was no difference between groups in the incidence of respiratory depression, confirming previous research that supplemental oxygen does not exacerbate respiratory depression
  • 5 patients in the compressed air group developed hypoxia without preceding respiratory depression, so capnography cannot be completely relied on in this setting.

They summarise:
“…assuming that capnography is in place to monitor ventilatory function, our results strongly support the routine use of high-flow oxygen during ED propofol sedation”

STUDY OBJECTIVE: We determine whether high-flow oxygen reduces the incidence of hypoxia by 20% in adults receiving propofol for emergency department (ED) sedation compared with room air.

METHODS: We randomized adults to receive 100% oxygen or compressed air at 15 L/minute by nonrebreather mask for 5 minutes before and during propofol procedural sedation. We administered 1.0 mg/kg of propofol, followed by 0.5 mg/kg boluses until the patient was adequately sedated. Physicians and patients were blinded to the gas used. Hypoxia was defined a priori as an oxygen saturation less than 93%; respiratory depression was defined as an end tidal CO(2) greater than 50 mm Hg, a 10% absolute change from baseline, or loss of waveform.

RESULTS: We noted significantly less hypoxia in the 59 patients receiving high-flow oxygen compared with the 58 receiving compressed air (19% versus 41%; P=.007; difference 23%; 95% confidence interval 6% to 38%). Respiratory depression was similar between groups (51% versus 48%; difference 2%; 95% confidence interval -15% to 22%). We observed 2 adverse events in the high-flow group (1 hypotension, 1 bradycardia) and 2 in the compressed air group (1 assisted ventilation, 1 hypotension).

CONCLUSION: High-flow oxygen reduces the frequency of hypoxia during ED propofol sedation in adults.

The Utility of High-Flow Oxygen During Emergency Department Procedural Sedation and Analgesia With Propofol: A Randomized, Controlled Trial
Ann Emerg Med. 2011 Oct;58(4):360-364

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