A new nasal mask vs. conventional nasal cannulas to oxygenate overweight or obese patients during sedation for painless gastroscopy: a randomized controlled trial

Overweight and obese patients undergoing painless gastroscopy are at increased risk of hypoxemia during propofol-sufentanil anesthesia, with conventional oxygenation strategies often proving insufficient. This study aimed to evaluate the efficacy of a novel nasal mask oxygenation protocol using a commercially available disposable anesthesia nasal mask in reducing the incidence of hypoxemic events during propofol-sufentanil-based sedation in this high-risk population. A total of 127 patients were randomly assigned to either the nasal mask group (N group, N.=64) or the nasal cannula group (C group, N.=63). Following preoxygenation, sufentanil and propofol were given until MOAA/S≤1. The main outcomes were the incidence of mild-to-moderate and severe hypoxemia, total incidence of hypoxemia, lowest SpO<inf>2</inf>, and airway interventions. Secondary outcomes included satisfaction ratings and any adverse events occurring during the perioperative period. In comparison with the C group, the N group demonstrated significantly lower overall incidence of hypoxemia (10.9% vs. 36.5%, P=0.001), a reduction in severe hypoxemia (1.6% vs. 12.7%, P=0.036), and fewer airway interventions (9.4% vs. 34.9%, P=0.001). Both anesthesiologists and endoscopists reported greater satisfaction in the N group (P=0.041, P=0.011), while the rates of adverse event rates were similar between the groups. The nasal mask significantly decreases the occurrence of hypoxemia, reduces the rate of airway interventions, and enhances both procedural safety and satisfaction for overweight or obese patients undergoing painless gastroscopy.