Ventilation strategies in gastrointestinal endoscopy

Spontaneous breathing is the default mode of ventilation for procedures in gastrointestinal (GI) endoscopy. Sedative–hypnotic medications profoundly impair respiratory control and airway patency. Fundamental physiology of hypoventilation is reviewed in the context of the patient presenting for interventional endoscopy. The endoscopy setting presents unique challenges for airway management and ventilation. These include a shared airway, patient-positioning, and out-of-Operating Room location. Strategies to support airway patency, oxygenation, and ventilation that are commonly employed in the controlled setting of the operating room can be effectively adapted to the GI endoscopy suite. Techniques discussed include nasal airway devices/CPAP, pressure-support ventilation, jet ventilation, and inhaled mask anesthesia.Endoscopic procedures are amenable to a variety of approaches for airway management, maintenance of oxygenation, and ventilation. Important considerations include (1) patient comorbidities, (2) nonstandard positioning, (3) the concept of a shared airway, (4) anesthetic-associated respiratory depression and upper airway collapse, and (5) type and duration of the procedure (lower endoscopy, upper endoscopy, or ERCP). This review provides practical strategies while addressing elements of basic physiology for the anesthesia provider in the GI endoscopy setting.