Apneic Oxygenation During Prolonged Laryngoscopy in Obese Patients: a Randomized, Double-Blinded, Controlled Trial of Nasal Cannula Oxygen Administration

Moon, Tiffany S.; Tai, Katie; Kim, Agnes; Gonzales, Michael X.; Lu, Rachael; Pak, Taylor; Smith, Katelynn M.; Chen, Joy L.; Minhajuddin, Abu; Nnamani, Nwamaka; Fox, Pamela E.; Ogunnaike, Babatunde

doi:10.1007/s11695-019-04077-y

Cited by 30 publications

(22 citation statements)

References 22 publications

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“…This provides valuable additional time to secure the airway. Our results found that the barrier box did not prolong TTI in non–morbidly obese (BMI < 35) patients with normal airway assessment to cause any clinically significant hypoxia and falls within the safe period of apnea tolerated by most patients [ 15 – 17 ]. Our secondary endpoints show that the box did not increase the number of attempts at intubation.…”

Section: Discussionmentioning

confidence: 91%

“…Non- inferiority margin of 15 s was considered acceptable while comparing airway manipulation in both the groups based on our clinical experience and pilot study data. Our literature review showed that this non-inferiority margin (Δ = 15 s) would be within safe period of apnea tolerated by most patients [ 15 ]. Our secondary endpoints were total induction time, number of attempts at intubation, and lowest saturations observed during anesthetic induction and need for BMV.…”

Section: Methodsmentioning

confidence: 99%

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Time to adapt in the pandemic era: a prospective randomized non –inferiority study comparing time to intubate with and without the barrier box

et al. 2020

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Background The challenges posed by the spread of COVID-19 disease through aerosols have compelled anesthesiologists to modify their airway management practices. Devices such as barrier boxes are being considered as potential adjuncts to full PPE’s to limit the aerosol spread. Usage of the barrier box raises concerns of delay in time to intubate (TTI). We designed our study to determine if using a barrier box with glidescope delays TTI within acceptable parameters to make relevant clinical conclusions. Methods Seventy-eight patients were enrolled in this prospective non-inferiority controlled trial and were randomly allocated to either group C (without the barrier box) or the study group BB (using barrier box). The primary measured endpoint is time to intubate (TTI), which is defined as time taken from loss of twitches confirmed with a peripheral nerve stimulator to confirmation of end-tidal CO 2. 15 s was used as non-inferiority margin for the purpose of the study. We used an unpaired two-sample single-sided t-test to test our non- inferiority hypothesis (H 0: Mean TTI diff ≥15 s, H A: Mean TTI diff < 15 s). Secondary endpoints include the number of attempts at intubation, lowest oxygen saturation during induction, and the need for bag-mask ventilation. Results Mean TTI in group C was 42 s (CI 19.2 to 64.8) vs. 52.1 s (CI 26.1 to 78) in group BB. The difference in mean TTI was 10.1 s (CI -∞ to 14.9). We rejected the null hypothesis and concluded with 95% confidence that the difference of the mean TTI between the groups is less than < 15 s (95% CI -∞ to 14.9,p = 0.0461). Our induction times were comparable (67.7 vs. 65.9 s).100% of our patients were intubated on the first attempt in both groups. None of our patients needed rescue breaths. Conclusions We conclude that in patients with normal airway exam, scheduled for elective surgeries, our barrier box did not cause any clinically significant delay in TTI when airway manipulation is performed by well-trained providers. The study was retrospectively registered at clinicaltrials.gov (NCT04411056) on May 27, 2020.

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Section: Discussionmentioning

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Time to adapt in the pandemic era: a prospective randomized non –inferiority study comparing time to intubate with and without the barrier box

et al. 2020

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“…15 There have been no studies of comparable size with the exception of one, studying obese patients, in which the maximum apnoea time was 6 min. 16 In the FM group, a lower proportion tolerated apnoea without desaturation, suggesting that HFNO improves the efficiency of apnoeic oxygenation. The only directly comparable study is in non-obese older patients which reported similar results.…”

Section: Apnoea Duration (Min)mentioning

confidence: 90%

Apnoeic oxygenation in morbid obesity: a randomised controlled trial comparing facemask and high-flow nasal oxygen delivery

Schutzer-Weissmann¹,

Wojcikiewicz²,

Karmali³

et al. 2023

British Journal of Anaesthesia

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Background: Obesity is a risk factor for airway-related incidents during anaesthesia. High-flow nasal oxygen has been advocated to improve safety in high-risk groups, but its effectiveness in the obese population is uncertain. This study compared the effect of high-flow nasal oxygen and low-flow facemask oxygen delivery on duration of apnoea in morbidly obese patients. Methods: Morbidly obese patients undergoing bariatric surgery were randomly allocated to receive either high-flow nasal (70 L min À1 ) or facemask (15 L min À1 ) oxygen. After induction of anaesthesia, the patients were apnoeic for 18 min or until peripheral oxygen saturation decreased to 92%. Results: Eighty patients were studied (41 High-Flow Nasal Oxygen, 39 Facemask). The median apnoea time was 18 min in both the High-Flow Nasal Oxygen (IQR 18e18 min) and the Facemask (inter-quartile range [IQR], 4.1e18 min) groups. Five patients in the High-Flow Nasal Oxygen group and 14 patients in the Facemask group desaturated to 92% within 18 min. The risk of desaturation was significantly lower in the High-Flow Nasal Oxygen group (hazard ratio¼0.27; 95% confidence interval [CI], 0.11e0.65; P¼0.007). Conclusions: In experienced hands, apnoeic oxygenation is possible in morbidly obese patients, and oxygen desaturation did not occur for 18 min in the majority of patients, whether oxygen delivery was high-flow nasal or low-flow facemask. High-flow nasal oxygen may reduce desaturation risk compared with facemask oxygen. Desaturation risk is a more clinically relevant outcome than duration of apnoea. Individual physiological factors are likely to be the primary determinant of risk rather than method of oxygen delivery. Clinical trial registration: NCT03428256.

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“…Our results found that the barrier box did not prolong TTI in non-morbidly obese (BMI < 35), COVID negative patients with normal airway assessment to cause clinically signi cant hypoxia and is within the safe period of apnea tolerated by most patients. (15)(16)(17) Our secondary endpoints show that the box did not increase the number of attempts at intubation. None of the patients needed bag-mask ventilation prior to intubation, which is essential during this pandemic era as bag-mask ventilation can increase the aerosol generation.…”

Section: Discussionmentioning

confidence: 75%

Time to adapt in the pandemic era: A prospective randomized non–inferiority study comparing time to intubate with and without the barrier box

Madabhushi

Kinthala

Ankam

et al. 2020

Preprint

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Background The challenges posed by the spread of COVID-19 disease through aerosols have compelled anesthesiologists to modify their airway management practices. Devices such as barrier boxes are being considered as potential adjuncts to full PPE's to limit the aerosol spread. Usage of the barrier box raises concerns of delay in time to intubate (TTI). We designed our study to determine if using a barrier box with glidescope delays TTI within acceptable parameters to make relevant clinical conclusions.Methods 78 patients were enrolled in this prospective non inferiority controlled trial and were randomly allocated to group C (without the barrier box) or the study group BB (using barrier box). The primary measured endpoint is time to intubate (TTI), which is defined as time taken from loss of twitches confirmed with a peripheral nerve stimulator to confirmation of end-tidal CO 2. 15 seconds was used as non-inferiority margin for the purpose of the study .We used an unpaired two-sample single-sided t-test to test our non- inferiority hypothesis (H 0 : Mean TTI diff ≥ 15 seconds, H A : Mean TTI diff < 15 seconds). Secondary endpoints include the number of attempts at intubation, lowest oxygen saturation during induction, and the need for bag-mask ventilation.Results Mean TTI in group C was 42 (CI 19.2 to 64.8) seconds vs. 52.1 (CI 26.1 to 78) seconds in group BB. The difference in mean TTI was 10.1 seconds (CI -∞ to 14.9). We rejected the null hypothesis and concluded with 95% confidence that the difference of the mean TTI between the groups is less than < 15 seconds (95% CI -∞ to 14.9,p = 0.0461). Our induction times were comparable (67.7 vs. 65.9 seconds).100% of our patients were intubated on the first attempt in both groups. None of our patients needed rescue breaths.Conclusions We conclude that in patients with normal airway exam, scheduled for elective surgeries, our barrier box did not cause any clinically significant delay in TTI when airway manipulation is performed by well-trained providers.The study was retrospectively registered at clinicaltrials.gov (NCT04411056) on May 27, 2020

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Apneic Oxygenation During Prolonged Laryngoscopy in Obese Patients: a Randomized, Double-Blinded, Controlled Trial of Nasal Cannula Oxygen Administration

Cited by 30 publications

References 22 publications

Time to adapt in the pandemic era: a prospective randomized non –inferiority study comparing time to intubate with and without the barrier box

Time to adapt in the pandemic era: a prospective randomized non –inferiority study comparing time to intubate with and without the barrier box

Apnoeic oxygenation in morbid obesity: a randomised controlled trial comparing facemask and high-flow nasal oxygen delivery

Time to adapt in the pandemic era: A prospective randomized non–inferiority study comparing time to intubate with and without the barrier box

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