Efficacy of enhanced preoxygenation protocols in mitigating hypoxemia during propofol sedation for gastrointestinal endoscopic procedures: a prospective, randomized, controlled study.

Abstract

JOURNAL/mgres/04.03/01612956-202603000-00003/figure1/v/2025-06-28T140100Z/r/image-tiff Hypoxemia during propofol sedation for gastrointestinal endoscopic procedures is a significant risk and is often exacerbated by inadequate preoxygenation. Effective preoxygenation strategies are essential for reducing the incidence of hypoxemia, especially in high-risk patients. This study aimed to evaluate the efficacy of an enhanced preoxygenation protocol for mitigating hypoxemia during propofol sedation during gastroscopy. In a prospective, randomized, controlled design, patients undergoing gastroscopy were assigned to either an intervention group (enhanced preoxygenation) or a nonintervention group (standard care). The intervention protocol involved the administration of eight tidal volume breaths over 1 minute at an oxygen flow rate of 10 L/min via a tight-fitting face mask, with clinical supervision by an endoscopy nurse. The primary outcome was the incidence of hypoxemia, defined as a peripheral oxygen saturation level of less than 90% at any point during the gastroscopy procedure. Compared with the nonintervention group, the intervention group had a significantly lower incidence of hypoxemia. This effect was particularly pronounced in high-risk patients, including elderly individuals and those with elevated body mass indices. No significant adverse events were observed during the procedure. These results suggest that enhanced preoxygenation may effectively alleviate the occurrence of hypoxemia during propofol sedation in gastrointestinal endoscopic procedures. Further research is needed to assess the broader applicability of this approach and explore additional strategies for optimizing preoxygenation in endoscopic procedures.