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Hypoxemia during upper gastrointestinal (GI) endoscopy, bronchoscopy,transesophageal echocardiography and fibreoptic endotracheal intubation, mainly due to hypoventilation, continue to concern the gastroenterologists, pulmonologists,cardiologists 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 small children, general endotracheal anesthesia seems to be the preferred option for most GI endoscopic procedures.
With the availability of Goudra Bite Block, Goudra Ventilating Bite Block and Goudra Mask Airway(1,2), the incidence of hypoxemia during these procedures under all types of sedation is likely to fall significantly. It might allow greater flexibility in dosing sedation, with less fear of hypoxemia. Anesthesia providers might be able to use propofol mediated deep sedation in patients where endotracheal intubation is currently preferred. Additionally, the bite block might help to administer inhalational anesthesia during fibreoptic endotracheal intubation. Devices for pediatric use and for patients with in patients with limited mouth opening are available. We hope to have these devices in the US market by July 2015 as FDA clearance is pending.
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.
2. Basavana GG Goudra, Chandramouli M, Preet Mohinder Singh, Veerendra Sandur: Goudra bite block for upper gastrointestinal endoscopy. Journal of Research in Medical Sciences 19(11): 1112, November 2014.