Our hospital started using the Smart Capnoline nasal cannula for endoscopy cases.

http://www.oridion.com/eng/products/sampling-lines/filterline/non-intubated/smart-capno-line.asp

Today I was having a hell of a time with oxygen desaturations. I had one guy (400 lbs mind you) that was grabbing stuff and talking with a real sat of 55%. I've never seen such a thing! The patients are desating, despite having little anesthesia on board (as evidenced by grabbing and eyes open). I've received no training on this stuff, but the nurses there said that the cannula will only flow 5L/min max. Is anyone else using this and having issues? Thanks!

I'm not familiar with the O2 cannula you describe, but in my experience patients will become very agitated with hypoxia. Hypoxia will cause sympathetic nervous system stimulation, activating the 'fight or flight' reflex. A 400 lb man probably has periods of hypoxia on a daily basis, and is extremely high risk for IV sedation.

No, This is not movement related to hypoxia/delerium. I do the same thing maybe 10 patients/week. I (and 3 other CRNAs/2 MDAs) are having the same issues since starting this system last week. Nothing has changed in my technique except that my patients are desaturating all the time now??