Efficacy of preoxygenation with non-invasive low positive pressure ventilation in obese patients: Crossover physiological study

Géorgescu, Mihai; Tanoubi, Issam; Fortier, Louis‐Philippe; Donati, François; Drolet, Pierre

doi:10.1016/j.annfar.2012.05.003

Cited by 19 publications

(13 citation statements)

References 26 publications

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“…Induction of general anaesthesia per se as also the use of 100% oxygen during induction of anaesthesia results in the development of atelectasis in dependent lung regions within minutes of anaesthetic induction. [ 1 2 ] Application of continuous positive airway pressure (CPAP) during pre-oxygenation and induction of anaesthesia[ 3 4 5 ] helps to increase the duration of apnoea before the development of significant arterial desaturation by preventing atelectasis, increasing oxygen stores, and decreasing intrapulmonary shunt.…”

Section: Introductionmentioning

confidence: 99%

Effect of positive airway pressure during pre-oxygenation and induction of anaesthesia upon safe duration of apnoea

Sreejit

Ramesh²

2015

Indian J Anaesth

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Background and Aims:Induction of general anaesthesia per se as also the use of 100% oxygen during induction of anaesthesia, results in the development of atelectasis in dependent lung regions within minutes of anaesthetic induction. We aimed to assess the effect of application of a continuous positive airway pressure (CPAP) of 5 cm H2O during pre-oxygenation and induction of anaesthesia on the period of apnoea before the occurrence of clinically significant desaturation.Methods:In this prospective, randomised, and double-blind study, 40 patients posted for elective surgery were enrolled. Duration of apnoea was measured as the time from the administration of succinylcholine hydrochloride to the time when oxygen saturation fell to 93%. Student's t-test was used for comparing the duration of apnoea.Results:The safe duration of apnoea was found to be significantly longer in patients receiving CPAP of 5 cm H2O (Group P; n = 16) compared to the group receiving no CPAP (Group Z; n = 20), that is, 496.56 ± 71.68 s versus 273.00 ± 69.31 s (P < 0.001).Conclusion:The application of CPAP of 5 cm H2O using a Mapleson A circuit with a fixed positive end-expiratory pressure device during 5 min of pre-oxygenation with 100% oxygen prior to the induction of anaesthesia provides a clearly longer duration of apnoea before clinically significant arterial desaturation occurs.

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Section: Introductionmentioning

confidence: 99%

Effect of positive airway pressure during pre-oxygenation and induction of anaesthesia upon safe duration of apnoea

Sreejit

Ramesh²

2015

Indian J Anaesth

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“…). Preoxygenation is enhanced by augmenting functional residual capacity using non‐invasive ventilation, which increases the safe apnoea period by 50 per cent. Use of second‐generation supraglottic devices before laryngoscope‐guided intubation may extend the safe apnoea period by 50 per cent, compared with preoxygenation with CPAP.…”

Section: Resultsmentioning

confidence: 99%

Perioperative care of the obese patient

Carron

Fakhr

Ieppariello

et al. 2020

British Journal of Surgery

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Background Obesity has become an increasing problem worldwide during the past few decades. Hence, surgeons and anaesthetists will care for an increasing number of obese patients in the foreseeable future, and should be prepared to provide optimal management for these individuals. This review provides an update of recent evidence regarding perioperative strategies for obese patients. Methods A search for papers on the perioperative care of obese patients (English language only) was performed in July 2019 using the PubMed, Scopus, Web of Science and Cochrane Library electronic databases. The review focused on the results of RCTs, although observational studies, meta‐analyses, reviews, guidelines and other reports discussing the perioperative care of obese patients were also considered. When data from obese patients were not available, relevant data from non‐obese populations were used. Results and conclusion Obese patients require comprehensive preoperative evaluation. Experienced medical teams, appropriate equipment and monitoring, careful anaesthetic management, and an adequate perioperative ventilation strategy may improve postoperative outcomes. Additional perioperative precautions are necessary in patients with severe morbid obesity, metabolic syndrome, untreated or severe obstructive sleep apnoea syndrome, or obesity hypoventilation syndrome; patients receiving home ventilatory support or postoperative opioid therapy; and obese patients undergoing open operations, long procedures or revisional surgery.

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“…Supporting this are previous studies documenting that the spontaneous positive pressure ventilation strategy during preoxygenation leads to increased non-hypoxic apnea time 16,21 and greater end-tidal oxygen values. [22][23][24] The reason for this improvement in non-hypoxic apnea time, although having traditionally been attributed to increases in FRC, remains elusive. Consistent with these observations, the present study confirms that spontaneous ventilation with a positive pressure support strategy is favourable over the use of spontaneous ventilation without positive pressure support to increase FRC.…”

Section: Discussionmentioning

confidence: 99%

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

Couture

Provencher

Somma

et al. 2018

Can J Anesth/J Can Anesth

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Efficacy of preoxygenation with non-invasive low positive pressure ventilation in obese patients: Crossover physiological study

Cited by 19 publications

References 26 publications

Effect of positive airway pressure during pre-oxygenation and induction of anaesthesia upon safe duration of apnoea

Effect of positive airway pressure during pre-oxygenation and induction of anaesthesia upon safe duration of apnoea

Perioperative care of the obese patient

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

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