Novel mandibular advancement bite block with supplemental oxygen to both nasal and oral cavity improves oxygenation during esophagogastroduodenoscopy: a bench comparison

Wei Nung Teng, Chien Kun Ting, Yu Tzu Wang, Kuang Yao Yang, Mei Yung Tsou, Joseph A. Orr, Kyle M. Burk, Huihua Chiang*, Chun Li Lin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Drug-induced respiratory depression is a major cause of serious adverse events. Adequate oxygenation is very important during sedated esophagogastroduodenoscopy (EGD). Nasal breathing often shifts to oral breathing during open mouth EGD. A mandibular advancement bite block was developed for EGD using computer-assisted design and three-dimensional printing techniques. The mandible is advanced when using this bite block to facilitate airway opening. The device is composed of an oxygen inlet with one opening directed towards the nostril and another opening directed towards the oral cavity. The aim of this bench study was to compare the inspired oxygen concentration (FiO 2 ) provided by the different nasal cannulas, masks, and bite blocks commonly used in sedated EGD. A manikin head was connected to one side of a two-compartment lung model by a 7.0 mm endotracheal tube with its opening in the nasopharyngeal position. The other compartment was driven by a ventilator to mimic “patient” inspiratory effort. Using this spontaneously breathing lung model, we evaluated five nasal cannulas, two face masks, and four new oral bite blocks at different oxygen flow rates and different mouth opening sizes. The respiratory rate was set at 12/min with a tidal volume of 500 mL and 8/min with a tidal volume of 300 mL. Several Pneuflo resistors of different sizes were used in the mouth of the manikin head to generate different degrees of mouth opening. FiO 2 was evaluated continuously via the endotracheal tube. All parameters were evaluated using a Datex anesthesia monitoring system. The mandibular advancement bite block provided the highest FiO 2 under the same supplemental oxygen flow. The FiO 2 was higher for devices with oxygen flow provided via an oral bite block than that provided via the nasal route. Under the same supplemental oxygen flow, the tidal volume and respiratory rate also played an important role in the FiO 2 . A low respiratory rate with a smaller tidal volume has a relative high FiO 2 . The ratio of nasal to oral breathing played an important role in the FiO 2 under hypoventilation but less role under normal ventilation. Bite blocks deliver a higher FiO 2 during EGD. The ratio of nasal to oral breathing, supplemental oxygen flow, tidal volume, and respiratory rate influenced the FiO 2 in most of the supplemental oxygen devices tested, which are often used for conscious sedation in patients undergoing EGD and colonoscopy.

Original languageEnglish
Pages (from-to)523-530
Number of pages8
JournalJournal of Clinical Monitoring and Computing
Issue number3
StatePublished - 1 Jun 2019


  • Computer assisted design
  • Esophagogastroduodenoscopy
  • Mandibular advancement bite block
  • Oxygen delivery
  • Three-dimensional printing


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