Comparison of nitrous oxide to no sedation and deep sedation for diagnostic upper gastrointestinal endoscopy

In China, great efforts are dedicated to reducing discomfort and minimizing undesirable complications for patients undergoing upper gastrointestinal (UGI) endoscopy.

This study was conducted to compare the diagnostic accuracy, safety, complications, and patient and examiner satisfaction for different sedation approaches. We carried out a prospective and randomized study on 450 patients undergoing diagnostic UGI endoscopy. During the procedure, patients received N(2)O by inhalation; an intravenous mixture of midazolam, remifentanil, and propofol; or no sedative. The cardiorespiratory functions, procedure duration, recovery time, length of hospital stay, complications, and ratings of patient and examiner satisfaction were recorded.

Compared to those deeply sedated, patients inhaling N(2)O had comparable diagnostic accuracy, significantly shorter procedure and recovery times, a lower risk of cardiorespiratory distress, but a higher number of minor complications and post-procedure mental issues. The procedural satisfaction ratings were highest for those receiving deep sedation; fewer patients reported willingness to reconsider N(2)O for a future upper GI endoscopy. The lowest satisfaction rating was given by those who received no sedation.

Multiple factors should be considered before selecting N(2)O as the sedative for diagnostic UGI endoscopy, including the patient's economic status, potential risk of cardiorespiratory distress, and sensitivity to potential adverse effects of N(2)O administration.