{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T15:21:02Z","timestamp":1747149662208,"version":"3.40.5"},"reference-count":22,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,5,16]],"date-time":"2020-05-16T00:00:00Z","timestamp":1589587200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100013331","name":"American Society of Anesthesiologists","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013331","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Structural disorders of the hypopharynx can lead to dysphagia\u2010related morbidity. Endoscopic therapy in this area, for example, myotomy for Zenker's diverticulum (ZD), has traditionally been performed under general anesthesia (GA). We have developed a two\u2010stage sedation process, which is used along with high\u2010flow nasal oxygen therapy (HFNOT) to facilitate endoscopic hypopharyngeal procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this prospective, single\u2010center study, patients undergoing endoscopic procedures between June 2016 and March 2018 were included. All endoscopies were performed with propofol and\/or remifentanil and supported with HFNOT. In patients with ZD, the diverticulum and stomach were cleared of debris under conscious sedation to reduce the risk of aspiration, before sedation was deepened to facilitate myotomy. Sedation\u2010related adverse events were recorded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 50 patients were included for analysis (mean age of 71.1, range 31\u201393; 58% male); 48% were categorized as American Society of Anesthesiologists (ASA) Grade III and 6% as Grade IV. The median procedure time was 20\u2009min. Of patients, 83% were sedated with both propofol and remifentanil using a target\u2010controlled infusion under specialist anesthetic supervision. Sedation\u2010related adverse events included transient hypotension (38%), bradycardia (8%), and hypoxia (8%). No procedures were abandoned due to complications, and no patients required conversion to GA. Patients achieved full postprocedure recovery from sedation after a median duration of 5 min.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>HFNOT is a useful adjunct to two\u2010stage sedation, which can enable high\u2010risk patients to safely undergo deep sedation during hypopharyngeal endoscopic procedures.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jgh3.12348","type":"journal-article","created":{"date-parts":[[2020,5,16]],"date-time":"2020-05-16T13:56:33Z","timestamp":1589637393000},"page":"743-748","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Feasibility of high\u2010flow nasal oxygen therapy and two\u2010stage sedation during endoscopic hypopharyngeal therapy"],"prefix":"10.1002","volume":"4","author":[{"given":"Zoe","family":"Riddell","sequence":"first","affiliation":[{"name":"Anaesthetic Department Russells Hall Hospital  Dudley UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nickki","family":"Pressler","sequence":"additional","affiliation":[{"name":"Russells Hall Hospital  Dudley UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keith","family":"Siau","sequence":"additional","affiliation":[{"name":"Russells Hall Hospital  Dudley UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris J J","family":"Mulder","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Amsterdam University Medical Center  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hamid M","family":"Shalmani","sequence":"additional","affiliation":[{"name":"Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases Shahid Beheshti University of Medical Sciences  Tehran Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Downs","sequence":"additional","affiliation":[{"name":"Anaesthetic Department Russells Hall Hospital  Dudley UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Gait","sequence":"additional","affiliation":[{"name":"Anaesthetic Department Russells Hall Hospital  Dudley UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1458-4708","authenticated-orcid":false,"given":"Sauid","family":"Ishaq","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Russells Hall Hospital  Birmingham UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,5,16]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/den.13035"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0022215116007994"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2009.250"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.5152\/tjg.2015.150186"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2009.07.008"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/0003489417720220"},{"key":"e_1_2_5_8_1","first-page":"506382","article-title":"High\u2010flow nasal interface improves oxygenation in patients undergoing bronchoscopy","volume":"2012","author":"Lucangelo U","year":"2012","journal-title":"Crit. 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