Patient Safety
Anesthesiology patient safety literature1,2 clearly indicates that the majority of medical malpractice lawsuits arising from GI endoscopies are a result of respiratory complications, specifically hypoxia (inadequate, dangerously low blood oxygen levels). Hypoxia during endoscopy can result in prolongations, delays and cancellations of procedures, and even worse, in cardiac arrest, brain damage and death.
The greatest technical challenges to providing adequate oxygenation during upper endoscopies results from the fact that we have been unable to use our best method of supplemental oxygen delivery, the traditional oxygen facemask, for the simple reason that the plastic dome of the facemask prevents insertion of the endoscope into the patient's mouth. As a result, for decades, we have had to settle for our least effective method of oxygen delivery, namely nasal oxygen cannula, for upper endoscopies.
While nasal cannula provide an "open face" to allow oral insertion of the endoscope, the room air, which is entrained via the mouth with every breath, dilutes and severely limits the oxygen actually delivered to the lungs to a maximum of 35-40 percent, as opposed to the 85-100 percent oxygen concentrations that can be delivered by oxygen facemasks.
In recent years, however, there has been a major positive development in this area: oxygen facemasks designed for upper endoscopies and approved by the FDA, such as the Procedural Oxygen Mask, or POM from POM Medical, Simi Valley, California. The POM endoscopy oxygen mask resembles a traditional oxygen mask, except it has a self-sealing endoscopy port that allows insertion of the endoscope, while simultaneously providing much superior (2-3 times greater) oxygen delivery than nasal cannula.
In 2019, as part of an endoscopy patient safety initiative, our anesthesia department came across these new POM endoscopy oxygen masks, and incorporated them into our very busy endoscopy practice. The POM masks are inexpensive, easy to use, FDA approved and have greatly improved our ability to deliver adequate oxygenation during upper endoscopies.