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References and More Information

There are 14 million annual visits to the ED for respiratory illnesses in the US, not counting pandemic years [7].

There are 3.2 million hospital admissions per year for respiratory failure [8]

By 2030, nearly 1 in 2 adults in the US will be obese, and nearly 1 in 4 will have severe obesity [4]

Hypoxemia is reported in up to 54% of out of OR EGD cases [10]

With a prevalence of more than a billion people worldwide, sleep apnea has become a public health concern [1]. Its prevalence is up to 25% of adults in the US [2], and as high as 88% in patients presenting for bariatric surgery [3].

Both sleep apnea and obesity are independent risk factors for perioperative complications with up to 8 times the odds ratio for hypoxemia, and postoperative respiratory support [5]

There is a 33% reduction in the upper airway volume of patients with sleep apnea when they are put in operating position [9]

Inadequate oxygenation/ventilation is responsible for a third of legal claims in non-operating room anesthesia (NORA) cases [11]

  1. Cozowicz, Crispiana MD*; Memtsoudis, Stavros G. MD, PhD, MBA*,†. Perioperative Management of the Patient With Obstructive Sleep Apnea: A Narrative Review. Anesthesia & Analgesia 132(5):p 1231-1243, May 2021. | DOI: 10.1213/ANE.0000000000005444

  2. Vasu TS; Grewal R; Doghramji K. Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature. J Clin Sleep Med 2012;8(2):199-207.

  3. Mbadjeu Hondjeu AR, Chung F, Wong J. Perioperative management of Patients with Obstructive Sleep Apnea. Can Journ Gen Int Med [Internet]. 2022 Feb. 23 [cited 2023 May 5];17(SP1):1-16. Available from:

  4. Ward ZJ, Bleich SN, Cradock AL, Barrett JL, Giles CM, Flax C, Long MW, Gortmaker SL. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. N Engl J Med. 2019 Dec 19;381(25):2440-2450. doi: 10.1056/NEJMsa1909301. PMID: 31851800.

  5. Fassbender P, Herbstreit F, Eikermann M, Teschler H, Peters J. Obstructive Sleep Apnea-a Perioperative Risk Factor. Dtsch Arztebl Int. 2016 Jul 11;113(27-28):463-9. doi: 10.3238/arztebl.2016.0463. Erratum in: Dtsch Arztebl Int. 2016 Aug;113(31-32):524. PMID: 27476705; PMCID: PMC4973000.

  6. DePeau-Wilson M. Anesthesia outside of the OR: Cause for patient safety concerns? Medical News. Published January 13, 2023. Accessed May 5, 2023

  7. Ashman JJ, Cairns C, DeFrances CJ, Schwartzman A. Respiratory illness emergency department visits in the National Hospital Care Survey and the National Hospital Ambulatory Medical Care Survey. National Health Statistics Reports; no 151. Hyattsville, MD: National Center for Health Statistics. 2021

  8. Kempker, Jordan A. MD, MSc1; Abril, Maria K. MD1; Chen, Yunyun MSPH2; Kramer, Michael R. PhD3; Waller, Lance A. PhD2; Martin, Greg S. MD, MSc1. The Epidemiology of Respiratory Failure in the United States 2002–2017: A Serial Cross-Sectional Study. Critical Care Explorations 2(6):p e0128, June 2020. | DOI: 10.1097/CCE.0000000000000128

  9. Camacho M, Wei JM, Reckley LK, Song SA. Double Barrel Nasal Trumpets to Prevent Upper Airway Obstruction after Nasal and Non-Nasal Surgery. Anesthesiol Res Pract. 2018 Mar 20;2018:8567516. doi: 10.1155/2018/8567516. PMID: 29755518; PMCID: PMC5884407.

  10. Dimou, F., Huynh, S., Dakin, G. et al. Nasal positive pressure with the SuperNO2VA™ device decreases sedation-related hypoxemia during pre-bariatric surgery EGD. Surg Endosc 33, 3828–3832 (2019).

  11. Vlessides M. Catastrophic Sedation Errors Can Be Avoided by Using CO2 Monitoring And Following Guidelines. Published 2021. Accessed May 5, 2023. 

  12. Bhadoria, Pooja1,; Gupta, Gaurisha2; Agarwal, Anubha3. Viral Pandemics in the Past Two Decades: An Overview. Journal of Family Medicine and Primary Care 10(8):p 2745-2750, August 27, 2021. | DOI: 10.4103/jfmpc.jfmpc_2071_20

  13. Kiang MV, Carlasare LE, Thadaney Israni S, Norcini JJ, Zaman JAB, Bibbins-Domingo K. Excess Mortality Among US Physicians During the COVID-19 Pandemic. JAMA Intern Med. 2023 Apr 1;183(4):374-376. doi: 10.1001/jamainternmed.2022.6308. PMID: 36745424; PMCID: PMC10071333.

  14. Maggiore SM, Idone FA, Vaschetto R, Festa R, Cataldo A, Antonicelli F, Montini L, De Gaetano A, Navalesi P, Antonelli M. Nasal high-flow versus Venturi mask oxygen therapy after extubation. Effects on oxygenation, comfort, and clinical outcome. Am J Respir Crit Care Med. 2014 Aug 1;190(3):282-8. doi: 10.1164/rccm.201402-0364OC. PMID: 25003980.

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