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Hung KC, Ko CC, Chang PC, Wang KF, Teng IC, Lin CH, Huang PW, Sun CK. Efficacy of high-flow nasal oxygenation against peri- and post-procedural hypoxemia in patients with obesity: a meta-analysis of randomized controlled trials. Sci Rep 2022; 12:6448. [PMID: 35440712 PMCID: PMC9018711 DOI: 10.1038/s41598-022-10396-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/05/2022] [Indexed: 11/29/2022] Open
Abstract
This meta-analysis aimed at investigating the efficacy of high-flow nasal oxygenation (HFNO) against hypoxemia in patients with obesity compared with conventional oxygenation therapy and non-invasive ventilation. Databases were searched from inception to August 2021. Studies involving peri- or post-procedural use of HFNO were included. The primary outcome was risk of hypoxemia, while the secondary outcomes included status of oxygenation and carbon dioxide elimination. Ten randomized controlled trials (RCTs) were included. We found that HFNO prolonged the safe apnea time at induction compared to control group [mean difference (MD) = 73.88 s, p = 0.0004; 2 RCTs] with no difference in risk of peri-procedural hypoxemia [relative risk (RR) = 0.91, p = 0.64; 4 RCTs], minimum SpO2 (MD = 0.09%, p = 0.95; 4 RCTs), PaO2 (MD = − 8.13 mmHg, p = 0.86; 3 RCTs), PaCO2 (MD = − 6.71%, p = 0.2; 2 RCTs), EtCO2 (MD = − 0.28 mmHg, p = 0.8; 4 RCTs) between the two groups. HFNO also did not improve postprocedural PaO2/FiO2 ratio (MD = 41.76, p = 0.58; 2 RCTs) and PaCO2 (MD = − 2.68 mmHg, p = 0.07; 2 RCTs). This meta-analysis demonstrated that the use of HFNO may be associated with a longer safe apnea time without beneficial impact on the risk of hypoxemia, oxygenation, and CO2 elimination in patients with obesity. The limited number of trials warranted further large-scale studies to support our findings.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.,Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi Mei Medical Center, Tainan City, Taiwan.,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.,Weight Management Center, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.,Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.,Ph. D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Kuei-Fen Wang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - I-Chia Teng
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Chien-Hung Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Ping-Wen Huang
- Department of Emergency Medicine, Show Chwan Memorial Hospital, Changhua City, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan. .,College of Medicine, I-Shou University, Kaohsiung City, Taiwan.
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Rosén J, Frykholm P, Fors D. High-flow nasal cannula versus face mask for preoxygenation in obese patients: A randomised controlled trial. Acta Anaesthesiol Scand 2021; 65:1381-1389. [PMID: 34309839 DOI: 10.1111/aas.13960] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/30/2021] [Accepted: 07/13/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Preoxygenation efficacy with high-flow nasal cannula (HFNC) in obese patients is not clearly established. The primary aim of this study was to compare heated, humidified, high-flow nasal cannula with face mask for preoxygenation in this population. METHODS We conducted a single-centre, randomised, controlled trial. Forty subjects with BMI ≥ 35 kg m-2 were randomly assigned to receive 5.0 min of preoxygenation with face mask and 7 cm H2 O of PEEP (PEEP group) or HFNC at 70 L min-1 (HF group). Following induction, bag-mask ventilation continued until laryngoscopy, whereas HFNC was maintained before and during intubation. The primary outcomes were end-tidal fraction of oxygen (EtO2 ) at 2.5 and 5.0 min duration of preoxygenation. Secondary outcomes included PaO2 and PaCO2 at 2.5 and 5.0 min of preoxygenation and at intubation. RESULTS Mean (±SD) EtO2 was 0.89 (±0.04) versus 0.90 (±0.05) after 2.5 min (95% CI for mean difference -0.02, 0.04) and 0.93 (±0.02) versus 0.91 (±0.02) after 5.0 min of preoxygenation (95% CI for mean difference -0.03, -0.002) in the PEEP (n = 18) and HF group (n = 20), respectively. All subjects reached an EtO2 ≥ 0.85 at 5.0 min. There were no differences in mean PaO2 or PaCO2 during preoxygenation. Subjects in the HF group had a mean (±SD) apnoea time of 199 (±38) s, but no desaturation (SpO2 < 100%) occurred. CONCLUSIONS Face mask with PEEP was superior to HFNC for preoxygenation in obese subjects. HFNC provided adequate preoxygenation quality in all subjects and may be considered as an alternative to face mask in selected patients. TRIAL REGISTRATION #ISRCTN37375068 (www.isrctn.com).
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Affiliation(s)
- Jacob Rosén
- Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine Uppsala University Uppsala Sweden
| | - Peter Frykholm
- Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine Uppsala University Uppsala Sweden
| | - Diddi Fors
- Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine Uppsala University Uppsala Sweden
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Legg-St Pierre C, Desprez I, Chang S, Machin K, Ambros B. Effect of preoxygenation before isoflurane induction and rocuronium-induced apnea on time until hemoglobin desaturation in domestic chickens (Gallus gallus domesticus). Vet Anaesth Analg 2021; 48:524-531. [PMID: 34023230 DOI: 10.1016/j.vaa.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/18/2021] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the time to hemoglobin oxygen desaturation in chickens (Gallus gallus domesticus) with and without preoxygenation before isoflurane induction of anesthesia and rocuronium-induced apnea. STUDY DESIGN Prospective, randomized crossover study. ANIMALS A total of 10 healthy adult Lohmann Brown-Lite hens. METHODS Hens were anesthetized with isoflurane for intravenous (IV) and intraarterial catheter placement and allowed to fully recover from anesthesia. Hens in the preoxygenation treatment were administered oxygen (2 L minute-1) via a facemask for 3 minutes prior to induction of anesthesia with 3% isoflurane in oxygen. In the alternative treatment, hens were not preoxygenated prior to induction of anesthesia with isoflurane in oxygen. Apnea was then induced with rocuronium bromide (1.0 mg kg-1) administered IV, and anesthesia was maintained with IV propofol infusion. A cloacal pulse oximeter measured hemoglobin oxygen saturation (SpO2). Time was recorded from the start of apnea until SpO2 was 90% (desaturation). The trachea was intubated, and anesthesia was maintained with isoflurane in oxygen with manual ventilation until spontaneous breathing returned and SpO2 ≥ 99%. PaO2 was measured before each treatment, after preoxygenation, postinduction and at desaturation. Data were analyzed between treatments using Wilcoxon matched-pairs signed rank tests with Holm-Šidák multiple comparison test, and within treatments using Friedman test with Dunn's multiple comparison test (p < 0.05). Data are reported as median (range). RESULTS Time from start of apnea until hemoglobin desaturation was not significantly different between preoxygenated and nonpreoxygenated hens [26.5 (16-50) seconds and 24.0 (5-57) seconds, respectively; p = 0.25]. No differences in PaO2 between treatments were observed at any time point. CONCLUSIONS AND CLINICAL RELEVANCE Preoxygenation for 3 minutes before isoflurane mask induction of anesthesia and apnea does not significantly increase time until desaturation in hens.
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Affiliation(s)
- Crystalyn Legg-St Pierre
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Isabelle Desprez
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Stephanie Chang
- Department of Clinical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | - Karen Machin
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Barbara Ambros
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Is preoxygenation still important? New concepts. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2017. [DOI: 10.1016/j.tacc.2017.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sakles JC, Mosier JM, Patanwala AE, Dicken JM. Apneic oxygenation is associated with a reduction in the incidence of hypoxemia during the RSI of patients with intracranial hemorrhage in the emergency department. Intern Emerg Med 2016; 11:983-92. [PMID: 26846234 DOI: 10.1007/s11739-016-1396-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 01/13/2016] [Indexed: 11/26/2022]
Abstract
Critically ill patients undergoing emergent intubation are at risk of oxygen desaturation during the management of their airway. Patients with intracranial hemorrhage (ICH) are particularly susceptible to the detrimental effects of hypoxemia. Apneic oxygenation (AP OX) may be able to reduce the occurrence of oxygen desaturation during the emergent intubation of these patients. We sought to assess the effect AP OX on oxygen desaturation during the rapid sequence intubation (RSI) of patients with ICH in the emergency department (ED). We prospectively collected data on all patients intubated in an urban academic ED over the 2-year period from July 1, 2013 to June 30, 2015. Following each intubation, the operator completed a standardized continuous quality improvement (CQI) data form, which included information on patient, operator and intubation characteristics. Operators recorded data on the use of AP OX, the oxygen flow rate used for AP OX, and the starting and lowest saturations during intubation. Adult patients with ICH who underwent RSI by emergency medicine (EM) residents were included in the analyses. The primary outcome variable was any oxygen saturation <90 % during the intubation. We performed a backward stepwise multivariate logistic regression analysis to identify variables associated with oxygen desaturation. The primary independent variable of interest was the use of AP OX during the intubation. Inclusion criteria for the study was met by 127 patients. AP OX was used in 72 patients (AP OX group) and was not used in 55 patients (NO AP OX group). The incidence of desaturation was 5/72 (7 %) in the AP OX group and was 16/55 (29 %) in the NO AP OX group. In the multivariate logistic regression analysis the use of AP OX was associated with a reduced odds of desaturation (aOR 0.13; 95 % CI 0.03-0.53). Patients with ICH who received AP OX during RSI in the ED were seven times less likely to have an oxygen saturation of <90 % during the intubation compared to patients who did not receive AP OX. AP OX is a simple intervention that may minimize the risk of oxygen desaturation during the RSI of patients with ICH.
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Affiliation(s)
- John C Sakles
- Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ, USA.
| | - Jarrod M Mosier
- Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Asad E Patanwala
- Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, AZ, USA
| | - John M Dicken
- University of Arizona College of Medicine, Tucson, AZ, USA
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Oshan V, Plant N, Gopal P, Rajai A, Roberts SA, Walker RWM. The effect of age and increasing head-up tilt on pre-oxygenation times in children: a randomised exploratory study. Anaesthesia 2016; 71:429-36. [DOI: 10.1111/anae.13379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/29/2022]
Affiliation(s)
- V. Oshan
- Royal Manchester Children's Hospital; Manchester UK
| | - N. Plant
- Royal Manchester Children's Hospital; Manchester UK
| | - P. Gopal
- Royal Manchester Children's Hospital; Manchester UK
| | - A. Rajai
- Department of Research and Innovation; Central Manchester University Hospitals NHS Foundation Trust; Manchester Academic Health Science Centre; Manchester UK
| | - S. A. Roberts
- Centre for Biostatistics; Manchester Academic Health Science Centre; University of Manchester; Manchester UK
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McNally EM, Robertson SA, Pablo LS. Comparison of time to desaturation between preoxygenated and nonpreoxygenated dogs following sedation with acepromazine maleate and morphine and induction of anesthesia with propofol. Am J Vet Res 2009; 70:1333-8. [DOI: 10.2460/ajvr.70.11.1333] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jérémie N, Seltzer S, Lenfant F, Ricard-Hibon A, Facon A, Cabrita B, Messant I, d'Athis P, Freysz M. Rapid sequence induction: a survey of practices in three French prehospital mobile emergency units. Eur J Emerg Med 2006; 13:148-55. [PMID: 16679879 DOI: 10.1097/01.mej.0000209052.85881.e2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This prospective study was conducted in three mobile emergency and intensive care units. METHODS The patients were over 15 years of age and were not in cardiac arrest. The study was to compare practices in the three units with the guidelines drawn up by the Commission of Experts so as to define the main parameters for quality assurance. All of the patients involved were considered to have full stomachs and required rapid sequence induction. RESULTS This procedure comply the guidelines only in 45% of cases; in the other cases succinylcholine should have been administered (mobile emergency and intensive care unit A) and the Sellick manoeuvre should have been used (mobile emergency and intensive care unit A and B). Notwithstanding, these two centres treated more traumatized patients than mobile emergency and intensive care unit C, and use of the Sellick manoeuvre in such circumstances is questionable. CONCLUSIONS More training and greater diffusion of the protocols are required, especially with regard to doctors who intervene intermittently.
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Affiliation(s)
- Nicolas Jérémie
- Département d'Anesthésie Réanimation, SAMU 21, Hôpital Général, Dijon Cedex, France
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Hirsch J, Führer I, Kuhly P, Schaffartzik W. Preoxygenation: a comparison of three different breathing systems. Br J Anaesth 2001; 87:928-31. [PMID: 11878698 DOI: 10.1093/bja/87.6.928] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
An end-tidal expiratory oxygen concentration (FE'O2) greater than 0.90 is considered to be adequate for preoxygenation. This is generally achieved using a face mask, but this can be unsatisfactory in some patients. We compared preoxygenation in 30 healthy volunteers using a face mask, the NasOral system, which is a novel preoxygenation device, and a mouthpiece with a nose-clip. We measured the maximal FE'O2, the FE'O2 after 2 min and the time to reach maximal FE'O2 and recorded the subjective judgement of the volunteers. The maximal FE'O2 with face mask and mouthpiece was significantly greater than with the modified NasOral system (P<0.05 and P<0.01). With the former devices, a FE'O2 of 0.90 was achieved in 73% of the volunteers vs 46% with the modified NasOral system. Using the mouthpiece, the FE'O2 after 2 min was significantly higher than using the face mask (P<0.01) or the modified NasOral system (P<0.01). The time to maximal FE'O2 was significantly shorter using the modified NasOral system than with the face mask or mouthpiece (P<0.001 and P=0.0001). The volunteers gave more positive ratings to the face mask and mouthpiece than to the modified NasOral system (P<0.001 and P<0.01). We conclude that the use of a mouthpiece can improve preoxygenation in some patients. The results obtained with the modified NasOral system do not justify its introduction into clinical practice.
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Affiliation(s)
- J Hirsch
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Unfallkrankenhaus Berlin, Hospital of the Free University of Berlin, Germany
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Hardman JG, Wills JS, Aitkenhead AR. Factors determining the onset and course of hypoxemia during apnea: an investigation using physiological modelling. Anesth Analg 2000; 90:619-24. [PMID: 10702447 DOI: 10.1097/00000539-200003000-00022] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED We used the Nottingham Physiology Simulator to examine the onset and course of hypoxemia during apnea after pulmonary denitrogenation. The following factors, as possible determinants of the hypoxemia profile, were varied to examine their effect: functional residual capacity, oxygen consumption, respiratory quotient, hemoglobin concentration, ventilatory minute volume, duration of denitrogenation, pulmonary venous admixture, and state of the airway (closed versus open). Airway obstruction significantly reduced the time to 50% oxyhemoglobin saturation (8 vs 11 min). Provision of 100% oxygen rather than air to the open, apneic patient model greatly prolonged time to 50% oxyhemoglobin saturation (66 vs 11 min). Hemoglobin concentration, venous admixture, and respiratory quotient had small, insignificant effects on the time to desaturation. Reduced functional residual capacity, short duration of denitrogenation, hypoventilation, and increased oxygen consumption significantly shortened the time to 50% oxyhemoglobin saturation during apnea. IMPLICATIONS Reduction in oxygen levels during cessation of breathing is dangerous and common in anesthetic practice. We used validated, mathematical, physiological models to reveal the impact of physiological factors on the deterioration of oxygen levels. This study could not be performed on patients and reveals important information.
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Affiliation(s)
- J G Hardman
- University Department of Anesthesia, University Hospital, Queen's Medical Centre, Nottingham, United Kingdom
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Everatt J, Ng WS. Pre-oxygenation using face mask or mouthpiece with and without nose clip: patient preferences and efficacy. Anaesthesia 1998; 53:387-9. [PMID: 9613306 DOI: 10.1046/j.1365-2044.1998.00308.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We assessed the effectiveness of mouthpieces for oxygenation before induction of anaesthesia. In part 1 of the study we asked 52 day case patients whether they would prefer mask, mouthpiece, or mouthpiece with nose clip, and which they would be willing to use. In part 2 we pre-oxygenated 18 volunteers using each of the three methods in a crossover study. We measured time to 90% end tidal oxygen concentration (FE'O2), or maximum FE'O2 after 3 min if less than 90%. Of the patients surveyed, 20 (39%) preferred mask, 23 (44%) mouthpiece, one mouthpiece with nose clip and nine (17%) expressed no preference. Only 88% would be willing to use the face mask, but all would accept either the face mask or the mouthpiece with nose clip. In part 2 of the study, the mouthpiece alone proved significantly worse than the mask or mouthpiece with nose clip. The latter two did not differ significantly. Offering the alternative of mouthpiece with nose clip would increase patient acceptance of effective pre-oxygenation.
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Affiliation(s)
- J Everatt
- Department of Anaesthetics, University of Wales College of Medicine, Heath Park, Cardiff, UK
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Nitrous oxide inhalation as an adjunct to intravenous induction of general anaesthesia with propofol for day surgery. Eur J Anaesthesiol 1997. [DOI: 10.1097/00003643-199705000-00012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hett DA, Geraghty IF, Radford R, House JR. Routine pre-oxygenation using a Hudson mask. A comparison with a conventional pre-oxygenation technique. Anaesthesia 1994; 49:157-9. [PMID: 8129129 DOI: 10.1111/j.1365-2044.1994.tb03377.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Two techniques of pre-oxygenation were studied by continuous analysis of respired gases using a mass spectrometer in 10 healthy volunteers. The first was a conventional technique as commonly used in anaesthesia with a Bain system and tightly-fitting anaesthetic face-mask and an oxygen flow of 8 l.min-1. The second technique also used a Bain system with an oxygen flow of 8 l.min-1, but with a Hudson mask attached. The mean fractional end-tidal oxygen concentrations after 3 min were 0.812 and 0.46 respectively for each of the pre-oxygenation techniques against 0.16 for subjects breathing air. This represents a considerable increase in pulmonary oxygen reserve for both techniques. The second technique is not an alternative to conventional pre-oxygenation for emergency anaesthesia, but is a useful and simple method that is acceptable to both patient and anaesthetist in routine cases.
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Affiliation(s)
- D A Hett
- Department of Anaesthesia, Southampton General Hospital
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Kashyap L, Yaddanapudi LN. Arterial desaturation during induction with and without preoxygenation: evaluation of four techniques. Anaesth Intensive Care 1993; 21:811-3. [PMID: 8122739 DOI: 10.1177/0310057x9302100611] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The incidence and degree of hypoxaemia during induction of balanced anaesthesia and endotracheal intubation were studied prospectively in 80 healthy adults undergoing elective surgery randomly divided into four equal groups of 20. Group 1 was preoxygenated for three minutes. The other three groups were not preoxygenated. Groups 1 and 2 were ventilated with 100% oxygen, while Groups 3 and 4 were ventilated with 50% and 33% oxygen respectively. Anaesthesia was induced with thiopentone 3-5 mg/kg and endotracheal intubation was done after ventilating for one minute with the chosen gas. Arterial desaturation was measured by pulse oximetry. In Groups 1-3 there was a significant increase and in Group 4 a significant decrease in saturation from the preinduction value. The arterial oxygen saturation was similar in Groups 1 and 2. Two patients in Group 3 and four in Group 4 had hypoxaemia. This incidence was not statistically significant. We conclude that ventilation with 100% oxygen for one minute prior to intubation and preoxygenation for three minutes are equally effective in preventing hypoxaemia during induction.
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Affiliation(s)
- L Kashyap
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi
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Machlin HA, Myles PS, Berry CB, Butler PJ, Story DA, Heath BJ. End-tidal oxygen measurement compared with patient factor assessment for determining preoxygenation time. Anaesth Intensive Care 1993; 21:409-13. [PMID: 8214545 DOI: 10.1177/0310057x9302100406] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Time to adequate preoxygenation was assessed in 200 elective surgical patients, using measurement of end-tidal oxygen concentration. A variety of patient factors were assessed as to their ability to predict the time required to preoxygenate a patient. Of the 200 patients, 23 (11.5%) were unable to be adequately preoxygenated; most of these cases were due to a poor mask fit. The average time for preoxygenation was 154 seconds (range 43-364 seconds). Of those patients who could be preoxygenated, 46 (23%) required more than three minutes. Although a regression equation could be constructed to calculate time required for preoxygenation, the wide standard errors of the coefficients preclude a clinically useful predictive equation. We thus found that we could not accurately predict time required for preoxygenation and that a routine three minutes preoxygenation may not be sufficient for many patients. However, the measurement of end-tidal oxygen concentration is a very useful method of determining the end-point for preoxygenation.
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Affiliation(s)
- H A Machlin
- Department of Anaesthesia, Alfred Hospital, Melbourne, Victoria
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Abstract
The use of a simple oxygen facemask (Hudson) with high oxygen inflow (48 l.min-1) was investigated as a technique for pre-oxygenation, comparing it with the Magill system (oxygen flow: 100 ml.kg-1.min-1). One hundred and thirty-eight patients scheduled for elective gynaecological and orthopaedic surgery were studied: group 1, Hudson mask and group 2, Magill system (ASA 1-2, n = 107); group 3, Hudson mask and group 4, Magill system (ASA 3, n = 30). Pre-oxygenation was assessed by measuring the times to 97%, 95% and 93% arterial desaturation (finger pulse oximetry) following 3 min of pre-oxygenation. The times taken to achieve these end-points in all the study groups suggest that the Hudson mask offers an alternative technique for pre-oxygenation.
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Affiliation(s)
- R Ooi
- Magill Department of Anaesthetics, Westminister Hospital, London
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Head-Rapson AG, Ralston SJ, Snowdon SL. Profound desaturation following vomiting on induction. A case for routine pre-oxygenation. Anaesthesia 1992; 47:862-3. [PMID: 1443478 DOI: 10.1111/j.1365-2044.1992.tb03149.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Whilst participating in a clinical trial, a patient vomited during induction of anaesthesia. Subsequent analysis of the continuous record of oxygen saturation showed precipitous desaturation.
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Affiliation(s)
- A G Head-Rapson
- University Department of Anaesthesia, Royal Liverpool University Hospital
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