Transient hypoxia following nitrogen spray cryotherapy for Barrett’s Esophagus: A case report

The patient was a 70-year-old male with a past medical history significant for gastro esophageal reflux disease, Barrett’s Esophagus, and Class III obesity with a body mass index greater than 40. The patient had undergone previous radio frequency ablation for treatment of Barrett’s Esophagus. The patient presented for a surveillance endoscopy and nitrogen cryotherapy. A nasal cannula was placed with side stream capnography, and intravenous induction of anesthesia was performed with propofol and lidocaine. A propofol infusion was used for maintenance of anesthesia and titrated appropriately to maintain depth of anesthesia, the patient was breathing spontaneously for the duration of the case. The endoscope was introduced without complication. Nitrogen spray cryotherapy was performed for twenty seconds for two cycles at each treatment site. A total of four different sites were ablated. Ventilation tubing was inserted adjacent to the endoscope and suction aided ventilation of gases was performed through the ventilation tubing during, and for 20 seconds after the ablation procedure. The patient developed hypoxia with desaturation into the 80s by pulse oximetry during each ablation. The hypoxia resolved each time ablation was completed. The procedure was ultimately completed successfully and the patient was taken to the PACU with a nasal cannula in place which was ultimately discontinued, he was discharged without further episodes of hypoxia.