Purpose
From the perspective of infection prevention during the Coronavirus disease 2019 (COVID-19) pandemic, a recommendation was made to use surgical masks after extubation in patients in the operating room. For compliance with this recommendation, anesthesiologists need to administer oxygen to the patient with an oxygen mask over the surgical mask. However, no studies have investigated whether this method allows good maintenance of oxygenation in patients. This study aimed to investigate which method of oxygen administration lends itself best to use with a surgical mask in terms of oxygenation.
Method
We administered oxygen to the study subjects using all the following three methods in random order: an oxygen mask over or under a surgical mask and a nasal cannula under the surgical mask. Oxygenation was assessed using the oxygen reserve index (ORi) and end-tidal oxygen concentration (EtO2).
Result
This study included 24 healthy volunteers. ORi values with administration of oxygen were higher in the order of a nasal cannula under the surgical mask, an oxygen mask under the surgical mask, and an oxygen mask over the surgical mask, with median values of 0.50, 0.48, and 0.43, respectively, and statistically significant differences between all groups (P < 0.001). EtO2 values were in the same order as ORi, with median values of 33.0%, 31.0%, and 25%, respectively, and statistically significant differences between all groups (P < 0.001).
Conclusion
Wearing a surgical mask over the nasal cannula during oxygen administration is beneficial for oxygenation and might help prevent aerosol dispersal.
In recent years, endovascular aortic repair (EVAR) has been applied to cases of ruptured abdominal aortic aneurysm and has been reported to have mortality rates similar to open-abdominal synthetic graft replacement. Here, we report a case in which abdominal compartment syndrome (ACS) worsened after an emergency EVAR. A 62-year-old man had emergency EVAR performed on his abdominal aortic aneurysm, while an intra-aortic balloon occluder was placed in his descending aorta and the balloon was dilated. No endoleak was observed after the stent placement performed without the dilated balloon. However, his vital signs remained unstable, his abdominal bloating worsened, and his intra-abdominal pressure reached 50 mmHg, which led to ACS. We performed an emergency decompressive laparotomy, but the patient suffered cardiopulmonary arrest, and died during surgery. It may be important to perform early decompressive laparotomy if ACS is suspected, because, once ACS occurs, the probability of death increases even if the EVAR performed on ruptured aortic aneurysm is successful.
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