Efficacy of preoxygenation using tidal volume breathing: a comparison of Mapleson A, Bain's and Circle system

Arora, Saurabh; Gupta, Priyanka; Arya, Virender Kumar; Bhatia, Nidhi

doi:10.1016/j.bjane.2017.10.001

Cited by 3 publications

(4 citation statements)

References 18 publications

(30 reference statements)

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“…The differences in the duration of pre‐oxygenation could be seen as a weakness. However, studies have shown that any increase in pre‐oxygenation efficacy after three minutes is limited 22,23 …”

Section: Discussionmentioning

confidence: 99%

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Pre‐oxygenation using high‐flow nasal oxygen versus tight facemask in trauma patients undergoing emergency anaesthesia

Sjöblom,

Hedberg,

Gille

et al. 2023

Acta Anaesthesiol Scand

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BackgroundPatients suffering from major traumatic injuries frequently require emergency anaesthesia. Due to often compromised physiology and the time‐sensitive management, trauma patients may be more prone to desaturate during induction of anaesthesia. We hypothesised that pre‐oxygenation using high‐flow nasal oxygen would decrease the risk of desaturation during induction of anaesthesia in trauma patients and the study therefore aimed to compare the frequency of desaturation when pre‐oxygenation was performed with high‐flow nasal oxygen or a traditional facemask.MethodsThis exploratory, prospective, before‐and‐after study was conducted at the Karolinska University Hospital, Sweden. Adult (≥18 years of age) patients suffering major traumatic injuries needing emergency anaesthesia were included around the clock. Patients were pre‐oxygenated using a tight‐fitting facemask during the first nine months of enrollment. High‐flow nasal oxygen was then introduced as a method for pre‐oxygenation of trauma patients. The primary outcome was the proportion of patients desaturating <93% during induction of anaesthesia, assessed from the start of pre‐oxygenation until one minute after intubation. Secondary outcomes included perceived difficulty of pre‐oxygenation among anaesthetists (assessed on a scale between 1 and 10) and safety outcomes, such as incidence of regurgitations and intracranial gas (assessed radiologically).ResultsData from 96 patients were analysed. Facemask pre‐oxygenation was performed in 66 patients, while 30 patients were pre‐oxygenated with high‐flow nasal oxygen. The most frequent trauma mechanisms were stabbing injuries (n = 34 (35%)) and fall injuries (n = 21 (22%)). There were no differences in patient characteristics between the groups. Eight (12%) versus three (10%) patients desaturated <93% in the facemask and high‐flow nasal oxygen group respectively, OR 0.81 (95% CI 0.20–3.28), p = .76. Anaesthetists assessed pre‐oxygenation using high‐flow nasal oxygen as easier compared to facemask pre‐oxygenation. No patient in any group showed signs of regurgitation. Among patients with facial or skull fractures requiring anaesthesia before radiology was performed, intracranial gas was seen in four (40%) patients pre‐oxygenated with a facemask and in no patient pre‐oxygenated with HFNO (p = .23).ConclusionIn this prospective study investigating trauma patients undergoing emergency anaesthesia, we could not see any difference in the number of patients desaturating when pre‐oxygenation was performed with high‐flow nasal oxygen compared to a tight‐fitting facemask. Pre‐oxygenation using high‐flow nasal oxygen was assessed as easier compared to facemask pre‐oxygenation.

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Section: Discussionmentioning

confidence: 99%

“…However, studies have shown that any increase in preoxygenation efficacy after three minutes is limited. 22,23…”

Section: Limitationsmentioning

confidence: 99%

Pre‐oxygenation using high‐flow nasal oxygen versus tight facemask in trauma patients undergoing emergency anaesthesia

Sjöblom,

Hedberg,

Gille

et al. 2023

Acta Anaesthesiol Scand

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“…Many studies have reported on the time required for EtO 2 to reach 90% when using 100% oxygen for preoxygenation (3,(19)(20)(21); however, few studies have measured the time required for EtO 2 to reach 70% when using 80% oxygen. For this reason, we attempted to determine if there is a difference in preoxygenation time, using EtO 2 as an endpoint, between different oxygen concentrations (100% vs. 80%).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of preoxygenation with end-tidal oxygen when using different oxygen concentrations in patients undergoing general surgery: a single-center retrospective observational study

et al. 2022

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Background: Preoxygenation is a simple but very important procedure for preventing arterial desaturation.A higher fraction of inspired oxygen (FiO 2 ) increases atelectasis and 80% oxygen results in significantly less atelectasis than 100% oxygen. We investigated whether there was a difference in the duration of adequate preoxygenation when using 100% and 80% oxygen. The proportion of patients for whom >3 min was required to achieve adequate preoxygenation was also investigated. Methods: The VitalDB database of patients underwent general surgery between February 1, 2021 and November 12, 2021 was reviewed. The time between the start of preoxygenation and the point where a 10% difference between FiO 2 and end-tidal oxygen (EtO 2 ) was defined as the preoxygenation time. The patients were classified into 100% and 80% groups according to the oxygen concentration. Propensity score matching (PSM) was performed to control for potential confounding factors. Results: Only 330 of the 1,377 patients had sufficient data for analysis: 179 in the 80% group and 151 in the 100% group. After PSM, 143 patients in each group were analyzed. The median preoxygenation time was 143 s [interquartile range (IQR): 120.5-181.5 s] and 144 s (IQR: 109.75-186.25 s) in the 80% and 100% groups, respectively [P=0.605; median difference =−1 s; 95% confidence interval (CI): −13 to 10]. Of the patients, 27% required >3 min for adequate preoxygenation.Conclusions: No difference in preoxygenation time was found between the 80% and 100% groups. For some patients, breathing for 3 min is not sufficient for adequate preoxygenation. EtO 2 monitoring aids evaluation of whether preoxygenation was adequate.

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“…Various parameters affecting non-hypoxic apnoea duration following pre-oxygenation have been studied e.g., duration of preoxygenation 3 , circuits used for pre-oxygenation 4,5 position during pre-oxygenation 6 e.g. supine, head up or sitting position has been studied.…”

Section: Introductionmentioning

confidence: 99%

Compare the Mean Non Hypoxic Apnea Duration of 20° Head up with Conventional Supine Position during Pre-oxygenation in Patients Undergoing Elective Surgery

Firdous¹,

Ali²,

Khan³

et al. 2022

PJMHS

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Introduction: Pre-oxygenation is routinely carried out before general anaesthesia with the aim of maximizing oxygen stores in the functional residual capacity of the lungs. This’s a method to avoid hypoxia during the apnoeic interval after general anesthetic induction. When initiating general anaesthesia, it is a practice to pre-oxygenate for 3 minutes in the supine position, since this is considered to be related with reduced cardiovascular instability. While the best timing for pre-oxygenation has been found, the best body posture for pre-oxygenation has yet to be determined. Objective: To compare the mean non hypoxic apnea duration of 20° head up with conventional supine position during pre-oxygenation in patients undergoing elective surgery Design of the study: Randomized Controlled Trial Setting: This study was conducted in the Operative Rooms of Jinnah Hospital, Lahore Result: Total 200 patients included, the mean age was 26.21+5.21 in Group A & 24.87+4.69 in Group B. The age range was 15-50 years, 41%(n=41) in Group A 39%(n=39) & in Group B between 15-25 years of age which was in majority. There were 45(45%) males and 55(55%) in Group A & 51.0(51%) male and 49.0(49%) female in Group B which shows that basic demographics were insignificant in both groups while comparing the mean non hypoxic apnea duration of 20° head up with conventional supine position during pre-oxygenation in patients undergoing elective surgery, we revealed 352.28+74.43 in Group A and 449.75+67.31 in Group B, p value was calculated as 0.04 i.e. ≤0.05 Conclusion: Comparison of the average non hypoxic apnea duration of 20° head up with conventional supine position during pre-oxygenation in patients undergoing elective surgery reveals prolonged duration in patients with 20° head up than conventional supine position during pre-oxygenation. Keywords: Mean non hypoxic apnea duration, 20° head up, conventional supine position, pre-oxygenation

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Efficacy of preoxygenation using tidal volume breathing: a comparison of Mapleson A, Bain's and Circle system

Cited by 3 publications

References 18 publications

Pre‐oxygenation using high‐flow nasal oxygen versus tight facemask in trauma patients undergoing emergency anaesthesia

Pre‐oxygenation using high‐flow nasal oxygen versus tight facemask in trauma patients undergoing emergency anaesthesia

Efficacy of preoxygenation with end-tidal oxygen when using different oxygen concentrations in patients undergoing general surgery: a single-center retrospective observational study

Compare the Mean Non Hypoxic Apnea Duration of 20° Head up with Conventional Supine Position during Pre-oxygenation in Patients Undergoing Elective Surgery

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