This project aimed to develop and implement a nasal ventilation mask (NVM) guideline to reduce the incidence of airway obstruction in patients undergoing outpatient endoscopy procedures. An observational design was utilized to evaluate the implementation of a NVM guideline as the oxygen delivery method for this patient population. An evidence-based guideline for use of a NVM was developed for patients with OSA and/or an elevated BMI of >35 kg/m2 undergoing esophagogastroduodenoscopy (EGD) and/or colonoscopy procedures at an outpatient endoscopy clinic. Patients receiving moderate or deep sedation for EGD, colonoscopy, or both procedures that had a BMI ≥ 35 kg/m2 and/or OSA diagnosis were observed for oxygen desaturation, airway maneuvers, and the use of airway adjuncts. Intraoperatively, the group of patients who wore a NVM (NVM group) compared to the group that did not wear a NVM (No NVM group) had: 1) 3 times greater chance of having at least 1 occurrence of an oxygen saturation <90% and 2) almost 4 times greater chance of having an oxygen desaturation >5% of baseline oxygen saturation. The NVM is a new product whose effectiveness has not been well demonstrated in the literature, yet its use is promising in the increasingly obese population.