Background: Despite evidence that high-flow nasal cannula oxygen therapy (HFNC) promotes oxygenation, its application in sedated gastroscopy in elderly patients has received little attention. This study investigated the effect of different inhaled oxygen concentrations (FiO₂) of HFNC during sedated gastroscopy in elderly patients. Methods: In a prospective randomized single-blinded study, 369 outpatients undergoing regular gastroscopy with propofol sedation delivered by an anesthesiologist were randomly divided into three groups (n = 123): nasal cannula oxygen group (Group C), 100% FiO₂ of HFNC group (Group H100), and 50% FiO₂ of HFNC (Group H50). The primary endpoint in this study was the incidence of hypoxia events with pulse oxygen saturation (SpO₂) ≤ 92%. The secondary endpoints included the incidence of other varying degrees of hypoxia and adverse events associated with ventilation and hypoxia. Results: The incidence of hypoxia, paradoxical response, choking, jaw lift, and mask ventilation was lower in both Group H100 and Group H50 than in Group C (P < 0.05). Compared with Group H100, Group H50 showed no significant differences in the incidence of hypoxia, jaw lift and mask ventilation, paradoxical response, or choking (P > 0.05). No patients were mechanically ventilated with endotracheal intubation or found to have complications from HFNC. Conclusion: HFNC prevented hypoxia during gastroscopy with propofol in elderly patients, and there was no significant difference in the incidence of hypoxia when FiO₂ was 50% or 100%. Trial registration: This single-blind, prospective, randomized controlled trial was approved by the Ethics Committee of Nanjing First Hospital (KY20201102-04) and registered in the China Clinical Trial Center (20/10/2021, ChiCTR2100052144) before patients enrollment. All patients signed an informed consent form.

BACKGROUND:Simulation-based training is essential for anesthesia residents to learn fiberoptic intubation safely. This study evaluated the effect of Supraglottic jet oxygenation and ventilation (SJOV) on skill acquisition, hypoxemia, and trainee performance during simulated difficult airway training. MATERIAL AND METHODS:This prospective randomized study included 20 third-year anesthesia residents without prior fiberoptic intubation experience. Each performed 25 fiberoptic intubations (total=500) on patients wearing a cervical collar to simulate a difficult airway. Residents were randomized to SJOV with 15 pounds per square inch (PSI), 15 breaths/min, fraction of inspired oxygen (FiO₂) 100%, or facemask ventilation. Primary outcomes were the number of cases to achieve procedural competency by cumulative sum (CUSUM) analysis, incidence of hypoxemia [peripheral oxygen saturation (SpO₂) <90%, and competency scores assessed by the Direct Observation of Procedural Skills (DOPS) and Mini-Clinical Evaluation Exercise (Mini-CEX). Secondary outcomes included intubation time and trainee-reported confidence and satisfaction. RESULTS:Residents in the SJOV group achieved competency after a median of 11 cases, compared with 18 cases in the facemask ventilation group. Hypoxemia occurred in 0% of the SJOV group versus 10% in the facemask ventilation group (P<0.001). DOPS scores were higher in the SJOV group (P=0.01), while Mini-CEX scores were similar (P=0.64). Residents using SJOV reported greater confidence (P=0.003), engagement (P=0.008), and satisfaction (P=0.012). CONCLUSIONS:SJOV accelerates skill acquisition, prevents hypoxemia, and improves performance during simulated difficult airway training. Integrating SJOV into residency programs may enhance the safety and efficacy of fiberoptic intubation training.