Prospective Experience of High-flow Nasal Oxygen During Bronchoscopy in 182 Patients: A Feasibility Study.

BACKGROUND: High-flow nasal oxygen (HFNO) has recently gained popularity during administration of anesthesia in a variety of circumstances, including apneic oxygenation. Fully qualified anesthesiologists provide sedation for our outpatient bronchoscopy service. We adopted this therapy to assess its efficacy providing optimal conditions (using a variety of sedation regimens) for patient and bronchoscopist. METHODS: We aimed to conduct a prospective feasibility evaluation. We collected data from all patients undergoing outpatient bronchoscopy or endobronchial ultrasound with anesthesiologist administered sedation over 21 months. Demographic data, high-flow settings, sedation techniques, and oxygen saturations (SpO2) were collected for each patient. Feedback from the bronchoscopists and anesthesiologists was recorded. Failure of the technique was defined as abandonment of the procedure or prolonged desaturation not amenable to basic airway maneuvers or increase in oxygen flow rate. RESULTS: All 182 patients underwent satisfactory bronchoscopy or endobronchial ultrasound. Mean age was 63 (±14) years. High-flow rate varied from 10 to 70 L/min. All patients received a remifentanil infusion and 175 (96%) had a propofol infusion. SpO2 before the procedure were lower (96%) than the highest saturation during the procedure with high flow (100%, P<0.0001). Ten patients transiently desaturated to <89%. Some had their flow rates increased, others required a transient jaw thrust, but all patient's saturations rapidly returned to satisfactory levels. One patient became apneic during sedation. Respiration returned after pausing the sedation and oxygen SpO2 remained above 93% throughout. All bronchoscopists and anesthesiologists were happy with the use of HFNO. CONCLUSION: HFNO has been shown to be effective in the outpatient bronchoscopy setting. Further evaluation regarding flow rates and levels of sedation is required.

QT Prolongation and delayed atrioventricular conduction caused by acute ingestion of trazodone.

Trazodone possesses minimal anticholinergic properties and, therefore, is generally regarded as having less cardiotoxic potential than other antidepressants. This report describes a young woman who developed significant QT prolongation and delayed atrioventricular nodal conduction after acute trazodone overdose. The case adds to the existing literature because it has a number of strengths, namely that confounding drugs and alcohol were lacking, trazodone exposure was confirmed by drug assay, and early presentation to hospital gave a valuable opportunity to study the time-course of the cardiac effects. This case reminds us to consider the possibility of cardiotoxic effects after trazodone overdose, even in young patients with no established cardiovascular disease.