SuperNOVA Nasal Mask Ventilation Maintains Oxygenation during Deep Sedation in High-Risk Patients: A Case Series.
With the recent trend of obesity, strategies for implementing a nasal
ventilation mask, as standard therapy for deep sedation are becoming increasingly important.
The prevalence of obesity has doubled since 1980, and the Centers for Disease Control
and Prevention report that more than two-thirds of U.S. adults
older than 20-years of age are overweight and 35.7% are obese.
Obese patients are at a further increased risk for hypoxemia during deep sedation due to a reduced functional residual capacity, increased oxygen consumption, and excess fat
deposition within the lateral pharyngeal walls that results in a smaller than normal pharyngeal volume.
The prevalence of obstructive sleep apnea is estimated to be approximately 25%, and as
high as 45% in obese patients, and the prevalence of OSA and its consequences are likely to increase in light of the current obesity epidemic.
The ASA Committee of Standards and Practice Parameters recommends providing every patient with a continuous course of passive supplemental oxygen and continuously monitoring oxygenation and ventilation during moderate or deep sedation procedures.
Unfortunately, recent prospective randomized controlled trials reported up to 54% of all
patients experience severe hypoxemia secondary to sedation-related upper airway obstruction and respiratory depression. The incidence is exacerbated by obesity and obstructive sleep apnea as independent risk factors with odds ratios 2-9 times that of normal weight patients.
Res Pract Anesthesiol Open J. 2018; 3(1): 15-19. doi: 10.17140/RPAOJ-3-119