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Hypoxemia during upper gastrointestinal (GI) endoscopy and bronchoscopy, mainly due to hypoventilation, continues to concern the gastroenterologists, pulmonologists and anesthesia providers. Until recently, the most popular method to prevent hypoxemia, is to increase the delivery of supplemental oxygen, while preserving spontaneous ventilation. However, with traditional oxygen delivery systems, it is difficult to increase the inspired oxygen concentrations above 51 percent. Endotracheal intubation is another option preferred by some anesthesia providers during advanced endoscopic procedures like Endoscopic retrograde cholangiopancreatography (ERCP). In children, general endotracheal anesthesia seems to be the preferred option for most GI endoscopic procedures.
With the availability of Goudra Bite Block and Goudra Airway(1), the incidence of hypoxemia during these procedures under all types of sedation is likely to fall significantly. It might allow gastroenterologists and pulmonologists to have greater flexibility in dosing sedation, with less fear of hypoxemia. Anesthesia providers, likewise, might be able to use propofol mediated deep sedation in patients where endotracheal intubation is currently preferred. Additionally, the bite block might help during fibreoptic endotracheal intubation. Devices for pediatric use and for patients with limited mouth opening will be available soon.
1. Goudra B, Chandramouli M, Singh P, Sandur V. Goudra ventilating bite block to reduce hypoxemia during endoscopic retrograde cholangiopancreatography. Saudi J Anaesth. 2014;8(2):299.