Critical Hemoglobin Desaturation Will Occur before Return to an Unparalyzed State following 1 mg/kg Intravenous Succinylcholine

Benumof, Jonathan L.; Dagg, Rachel; Benumof, Reuben

doi:10.1097/00000542-199710000-00034

Cited by 306 publications

(150 citation statements)

References 14 publications

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“…10 Measurements of arterial oxygen tension, 6,7 ETN 2 , 11 ETO 2 12,13 concentrations reflect the efficacy of preoxygenation, whereas the slowing of the rate of arterial oxyhemoglobin desaturation during apnea 10,14 is indicative of its efficiency. Since there are many factors that affect the decrease of arterial oxyhemoglobin saturation during apnea, such as capacity of oxygen loading and total oxygen consumption, 10,15,16 it is of utmost importance to maximally preoxygenate the patient to fill the alveolar and arterial compartments with oxygen, especially when difficult ventilation and/ or intubation are anticipated.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of preoxygenation using tidal volume and deep breathing techniques with and without prior maximal exhalation

Nimmagadda

Salem

Joseph

et al. 2007

Can J Anesth/J Can Anesth

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Purpose:We evaluated the influence of prior maximal exhalation on preoxygenation in 15 adult volunteers using tidal volume breathing (TVB) for five minutes and deep breathing (DB) for two minutes with and without prior maximal exhalation.Methods: Inspired and end-tidal oxygen, nitrogen and carbon dioxide were monitored continuously and recorded during room air breathing and at 30-sec intervals during 100% oxygen TVB or DB (rate of 8 breaths·min -1 ).Results: Tidal volume breathing with prior maximal exhalation resulted in an end-tidal oxygen concentration (ETO 2 ) slightly higher (P = 0.028) at 0.5 and 1.0 min as compared with TVB without prior maximal exhalation at the same time periods. Regardless of whether TVB was preceded by maximal exhalation or not, 2.5 min was required to reach a mean ETO 2 value of 90% or higher. With DB, there were no differences in ETO 2 values at any time period and 1.5 min was required to reach an ETO 2 of 90% or greater, with or without prior maximal exhalation. Conclusions:Maximal exhalation prior to TVB slightly steepens the initial rise in ETO 2 during the first minute, but confers no real benefit if maximal preoxygenation is the goal. Maximal exhalation prior to DB has no added value in enhancing preoxygenation.

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Section: Discussionmentioning

confidence: 99%

Efficacy of preoxygenation using tidal volume and deep breathing techniques with and without prior maximal exhalation

Nimmagadda

Salem

Joseph

et al. 2007

Can J Anesth/J Can Anesth

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“…Benumof used a modelling approach to determine what the arterial saturation would be by the time 1 mg.kg )1 suxamethonium had worn off and muscle twitch amplitudes had returned to between 10% and 90% of normal [9]. These data are reproduced in Fig.…”

Section: Relevance To the 'Can't Intubate Can't Ventilate' Situationmentioning

confidence: 96%

“…Both the American Society of Anesthesiologists and the Difficult Airway Society difficult airway algorithms recommend that if attempts to intubate the patient are unsuccessful, the patient should be allowed to awaken, by which it is assumed that the patient will return to an unparalysed state capable of resuming spontaneous ventilation and maintaining their own airway patency [9,10]. Benumof used a modelling approach to determine what the arterial saturation would be by the time 1 mg.kg )1 suxamethonium had worn off and muscle twitch amplitudes had returned to between 10% and 90% of normal [9].…”

Section: Relevance To the 'Can't Intubate Can't Ventilate' Situationmentioning

confidence: 99%

“…Third, (as Benumof suggested) a rescue manoeuvre (e.g. supraglottic airway) should be instigated early [9], and this practice is now part of airway management algorithms [10]. In turn, this emphasises the need to recognise a failed intubation scenario early, rather than persist with intubation attempts or rely upon even short-acting neuromuscular blockade wearing off (again a point made in the recent Fourth National Audit of the Royal College of Anaesthetists and Difficult Airway Society (NAP4) [12,13]).…”

Section: Relevance To the 'Can't Intubate Can't Ventilate' Situationmentioning

confidence: 99%

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Simulating hypoxia and modelling the airway

Farmery

2011

Anaesthesia

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SummaryApnoea due to airway obstruction is an ever present concern in anaesthesia and critical care practice and results in rapid development of hypoxaemia that is not always remediable by manual bag‐mask ventilation. As it is often difficult or impossible to study experimentally (although some historical animal data exist), it is useful to model the kinetics of hypoxaemia following airway obstruction. Despite being a complex event, the consequences of airway obstruction can be predicted with reasonable fidelity using mathematical and computer modelling. Over the last 15 years, a number of high fidelity mathematical and computer models have been developed, that have thrown light on this important event.

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“…8,9 The cLMA is recommended as an airway rescue device during failed tracheal intubation in North American guidelines. 10,11 The PLMA does not currently appear in the ASA or Canadian guidelines 11,12 but has recently been included in the management options in the algorithm for failed intubation during RSI by the United Kingdom Difficult Airway Society.…”

Section: Case #2mentioning

confidence: 99%

The Proseal™ LMA is a useful rescue device during failed rapid sequence intubation: two additional cases

et al. 2005

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P Pu ur rp po os se e: : We report two cases where the ProSeal™ laryngeal mask airway (PLMA) was successfully used as a rescue device, after failed tracheal intubation, during rapid sequence induction.C Cl li in ni ic ca al l f fi in nd di in ng gs s: : The first case involved a 31-yr-old primigravida presenting for emergency Cesarean section for severe fetal distress. She had a grade 3 larynx and airway edema was observed during laryngoscopy. Attempts with a McCoy blade and gum elastic bougie failed to secure the airway. A size 4 PLMA was inserted with good airway control and surgery proceeded uneventfully. The second case involved a 51-yr-old man presenting for appendectomy. Following failed attempts at intubation, a size 5 PLMA was succesful in securing his airway and surgery proceeded uneventfully.C Co on nc cl lu us si io on ns s: : The correctly placed PLMA has potential advantages over the cLMA for airway rescue in the circumstance of failed emergency intubation in a patient with a potentially full stomach. In the two cases reported, the PLMA provided effective rescue of the airway.Objectif : Présenter deux cas où le masque laryngé ProSeal™ (MLP) a servi d'instrument de secours après l'échec de l'intubation endotrachéale pendant une induction à séquence rapide.

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Critical Hemoglobin Desaturation Will Occur before Return to an Unparalyzed State following 1 mg/kg Intravenous Succinylcholine

Cited by 306 publications

References 14 publications

Efficacy of preoxygenation using tidal volume and deep breathing techniques with and without prior maximal exhalation

Efficacy of preoxygenation using tidal volume and deep breathing techniques with and without prior maximal exhalation

Simulating hypoxia and modelling the airway

The Proseal™ LMA is a useful rescue device during failed rapid sequence intubation: two additional cases

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