EXPERTS’ OPINION   Free access

Minerva Anestesiologica 2022 May;88(5):407-10

DOI: 10.23736/S0375-9393.21.16078-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

High-flow nasal oxygen, procedural sedation, and clinical governance

David TURNBULL ✉

Department of Anesthesia, Royal Hallamshire Hospital, Sheffield, UK

Procedural sedation for therapeutic and diagnostic procedures can now be achieved through deep sedation techniques that guarantee procedural success. Deep sedation techniques are delivered in a variety of non-theatre environments where the usual levels of anesthetic equipment are not practical or economical. Hypoxic events are particularly frequent, and challenge sedation providers. Traditional low flow nasal or facial oxygen therapy techniques are often insufficient to maintain acceptable oxygen levels and prevent peri-procedural hypoxia. High flow nasal oxygen delivers warm humidified oxygen up to 70 L/min, at oxygen concentrations between 21-100%, and reduces the incidence of hypoxic events. The provision of deep sedation is a complex process, fraught with risk, which can challenge even the skilled anesthetist. Therefore, regulatory authorities previously stipulated that anesthesia personnel be present during deep sedation. Changing attitudes by regulatory authorities and practical challenges providing anesthesia specialists have led to the acknowledgement that appropriately trained non-anesthetic staff can safely provide deep sedation. Deep sedation services are increasingly applied to subjects with complex co-morbidities, sometimes excluded for safety reasons from surgery under general anesthesia. The development of deep sedation services, delivered by non-anesthesia personnel, to patients with complex co-morbidities requires that services implement appropriate clinical governance tools to prevent deep sedation being the wild west of anesthesia services. Therefore, whilst high flow nasal oxygen may reduce the incidence of peri-procedural hypoxia, the introduction of clinical governance tools and the systematic introduction of initiatives to improve quality, will maintain the safety of deep sedation services.

KEY WORDS: Deep sedation; Hypoxia; Respiratory insufficiency; Clinical governance