Clinical Study High-Flow Nasal Cannula and Mandibular Advancement Bite Block Decrease Hypoxic Events during Sedative Esophagogastroduodenoscopy: A Randomized Clinical Trial Wei-Nung Teng , 1,2 Chien-Kun Ting , 1 Yu-Tzu Wang , 2 Ming-Chih Hou, 3 Wen-Kuei Chang, 1 Mei-Yung Tsou, 1 Huihua Chiang , 2 and Chun-Li Lin 2 1 Department of Anaesthesiology, Taipei Veterans General Hospital, Taipei City 11217, Taiwan 2 Department of Biomedical Engineering, National Yang-Ming University, Taipei City 11221, Taiwan 3 Department of Medicine, Taipei Veterans General Hospital, Taipei City 11217, Taiwan Correspondence should be addressed to Huihua Chiang; hkchiang@ym.edu.tw and Chun-Li Lin; cllin2@ym.edu.tw Received 13 May 2019; Revised 21 June 2019; Accepted 4 July 2019; Published 16 July 2019 Academic Editor: Hideo Inaba Copyright © 2019 Wei-Nung Teng et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. During sedated endoscopic examinations, upper airway obstruction occurs. Nasal breathing ofen shifs to oral breathing during open mouth esophagogastroduodenoscopy (EGD). High-fow nasal cannula (HFNC) which delivers humidifed 100% oxygen at 30 L min -1 may prevent hypoxemia. A mandibular advancement (MA) bite block with oxygen inlet directed to both mouth and nose may prevent airway obstruction during sedated EGD. Te purpose of this study was to evaluate the efcacy of these airway devices versus standard management. One hundred and eighty-nine patients were assessed for eligibility. One hundred and ffy-three were enrolled. Tis study randomly assigned eligible patients to three arms: the standard bite block and standard nasal cannula, HFNC, and MA bite block groups. EGD was performed afer anaesthetic induction. Te primary endpoint was the oxygen desaturation area under curve at 90% (AUC Desat ). Te secondary endpoints were percentage of patients with hypoxic, upper airway obstruction, and apnoeic and rescue events. One hundred and ffy-three patients were enrolled. AUCdesat was signifcantly lower for HFNC and MA bite blocks versus the standard management (p= 0.019). Te HFNC reduced hypoxic events by 18% despite similar airway obstruction and apnoeic events as standard group. Te MA bite block reduced hypoxic events by 12% and airway obstructions by 32%. Te HFNC and MA groups both showed a 16% and 14% reduction in the number of patients who received rescue intervention, respectively, compared to the standard group. Te HFNC and MA bite block may both reduce degree and duration of hypoxemia. HFNC may decrease hypoxemic events while maintaining nasal patency is crucial during sedative EGD. Te MA bite block may prevent airway obstruction and decrease the need for rescue intervention. 1. Introduction Te safety of sedation during esophagogastroduodenostomy (EGD) has long been a concern [1–3]. At least half of endoscopic procedures today are performed under moni- tored anaesthesia targeting deep sedation [4, 5]. Te goal of sedation during endoscopy is to reduce patient pain and anxiety and ultimately provide better quality examination and follow-up [6]. Sedation using common medications such as midazolam, opioids, and propofol causes respiratory depression, hypoventilation, and subsequent hypoxemia [7]. Airway management is crucial during deep sedation, since desaturation is noted in up to 60% of patients [8] and as high as 95% of patients have diferent degrees of airway obstruc- tion [9]. During deep sedation, the laryngeal muscle loses tone, causing partial or complete upper airway obstruction [10]. Te breathing pattern also changes from mainly nasal breathing of an awake patient to mainly oral breathing of a mouth-open sedated patient [11]. Trained personnel manage the airway by chin-lif, jaw thrust, insertion of nasal airway, or bag-mask ventilation [12]. Serious complications such as cardiopulmonary distress, hypotension, bradycardia, or the need for intubation may occur if the airway is not properly treated [13]. Hindawi BioMed Research International Volume 2019, Article ID 4206795, 7 pages https://doi.org/10.1155/2019/4206795