Effect of position and positive pressure ventilation on functional residual capacity in morbidly obese patients: a randomized trial

Couture, Étienne J.; Provencher, Steeve; Somma, Jacques; Lellouche, François; Marceau, Simon; Bussières, Jean S.

doi:10.1007/s12630-018-1050-1

Cited by 16 publications

(17 citation statements)

References 29 publications

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“…This is particularly applicable to morbidly obese patients and term parturients. [121][122][123][124] In addition, gentle FMV between loss of consciousness and beginning laryngoscopy is advocated. • Moderate to high risk of oxygen desaturation: For the patient at higher risk of oxygen desaturation with the onset of apnea, such as those with lower FRC and increased shunt fraction, the optimal pre-oxygenation strategy likely involves use of positive end-expiratory pressure or non-invasive positive pressure ventilation (NIV) during pre-oxygenation, [125][126][127][128] together with back up or reverse Trendelenburg positioning.…”

Section: Pre-oxygenationmentioning

confidence: 99%

“…96,98 ''Back up'' or reverse Trendelenburg positioning will help delay oxygen desaturation. [116][117][118][119][120][121][122][123][124] If general anesthesia is elected, careful pre-oxygenation must occur, with a goal of achieving FeO 2 C 0.9. • Apneic oxygenation is recommended during laryngoscopy and intubation of all morbidly obese patients when managed after the induction of general anesthesia.…”

Section: Post-proceduresmentioning

confidence: 99%

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Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Law

Duggan

Asselin

et al. 2021

Can J Anesth/J Can Anesth

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Purpose Since the last Canadian Airway Focus Group (CAFG) guidelines were published in 2013, the published airway management literature has expanded substantially. The CAFG therefore re-convened to examine this literature and update practice recommendations. This second of two articles addresses airway evaluation, decision-making, and safe implementation of an airway management strategy when difficulty is anticipated. Source Canadian Airway Focus Group members, including anesthesia, emergency medicine, and critical care physicians were assigned topics to search. Searches were run in the Medline, EMBASE, Cochrane Central Register of Controlled Trials, and CINAHL databases. Results were presented to the group and discussed during video conferences every two weeks from April 2018 to July 2020. These CAFG recommendations are based on the best available published evidence. Where high-quality evidence is lacking, statements are based on group consensus. Findings and key recommendations Prior to airway management, a documented strategy should be formulated for every patient, based on airway evaluation. Bedside examination should seek predictors of difficulty with face-mask ventilation (FMV), tracheal intubation using video- or direct laryngoscopy (VL or DL), supraglottic airway use, as well as emergency front of neck airway access. Patient physiology and contextual issues should also be assessed. Predicted difficulty should prompt careful decision-making on how most safely to proceed with airway management. Awake tracheal intubation may provide an extra margin of safety when impossible VL or DL is predicted, when difficulty is predicted with more than one mode of airway management (e.g., tracheal intubation and FMV), or when predicted difficulty coincides with significant physiologic or contextual issues. If managing the patient after the induction of general anesthesia despite predicted difficulty, team briefing should include triggers for moving from one technique to the next, expert assistance should be sourced, and required equipment should be present. Unanticipated difficulty with airway management can always occur, so the airway manager should have a strategy for difficulty occurring in every patient, and the institution must make difficult airway equipment readily available. Tracheal extubation of the at-risk patient must also be carefully planned, including assessment of the patient’s tolerance for withdrawal of airway support and whether re-intubation might be difficult.

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Section: Pre-oxygenationmentioning

confidence: 99%

Section: Post-proceduresmentioning

confidence: 99%

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Law

Duggan

Asselin

et al. 2021

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…In this case, severe obesity and intubation difficulties during preoperative airway evaluation were anticipated. Previous studies have shown that head-up [ 7 , 8 ] or beach-chair [ 9 ] positioning improves safe apnea time before the occurrence of significant hypoxemia. Furthermore, NHFC is effective for increasing apnea time under general anesthesia in obese patients and preventing a decrease in peripheral blood oxygen saturation (SpO 2 ) [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of a severely obese patient (body mass index 70.1 kg/m2) undergoing giant ovarian tumor resection: a case report

2022

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Background Giant ovarian tumors are rarely seen with severe obesity. There are few reports of perioperative management of giant ovarian tumors and severe obesity. Here, we report the perioperative management of physiological changes in massive intraabdominal tumors in a patient with severe obesity. Case presentation A 46-year-old Japanese woman (height 166 cm, weight 193.2 kg; body mass index 70.1 kg/m2) was scheduled to undergo laparotomy for a giant ovarian tumor. The patient was placed in the ramp position. Preoxygenation was performed using a high-flow nasal cannula, and awake tracheal intubation was performed using a video laryngoscope. Mechanical ventilation using a limited tidal volume with moderate positive end-expiratory pressure was applied during the surgical procedure. The aspiration speed for 15 L of tumor aspirate was set to under 1 L/minute, and the possibility of reexpansion pulmonary edema was foreseen by conventional monitoring. Conclusions We successfully completed anesthetic management in a patient with concomitant severe obesity and giant ovarian tumors.

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“…Many other studies have shown a similar positional effect. Couture et al [ 8 ] concluded that in the obese population, positioning patients with their heads above their feet by tilting the table 25 degrees, significantly increases FRC and oxygen storage capacity.…”

Section: Patient Positioningmentioning

confidence: 99%

Pre-oxygenation and apneic oxygenation in patients living with obesity – A review of novel techniques

Gaszyński

McKechnie

2022

Saudi J Anaesth

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Effect of position and positive pressure ventilation on functional residual capacity in morbidly obese patients: a randomized trial

Abstract: clinicaltrials.gov (NCT02121808). Registered 24 April 2014.

Cited by 16 publications

References 29 publications

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway

Anesthetic management of a severely obese patient (body mass index 70.1 kg/m2) undergoing giant ovarian tumor resection: a case report

Pre-oxygenation and apneic oxygenation in patients living with obesity – A review of novel techniques

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