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• W3036778727 abstract "Morbidly obese patients have reduced functional residual capacity, putting them at increased risk of critical desaturation during induction of anaesthesia.1 We aimed to compare the heated humidified high flow nasal cannula (HFNC) to standard management for preoxygenation, and oxygenation during apnoea and tracheal intubation in this patient population. We report preliminary data from a randomised, single-centre, open-labelled, controlled trial. After approval by the local ethics committee and written informed consent, patients scheduled for bariatric surgery were randomly assigned to receive 5 min of preoxygenation with 100% oxygen by a face mask with a PEEP of 7 cm H2O or HFNC set at 70 L min–1. Anaesthesia induction was followed by bag-mask ventilation continued until laryngoscopy or HFNC maintained during apnoea and intubation. The primary endpoint was fraction of end tidal oxygen (ETO2). The secondary endpoints were arterial oxygen partial pressure (Pao2) and peripheral capillary oxygen saturation (SpO2). Measurements were performed at baseline, after 2.5 and 5 min of preoxygenation, and repeated immediately after intubation. Apnoea time was defined as time from last spontaneous breath vs time from discontinuation of bag-mask ventilation to confirmation of correct tracheal tube placement in the HFNC and face mask group, respectively. Nineteen patients were available for statistical analysis. The mean BMI was 42 (2.5) kg m–2 in the face mask group (n=8) and 40 (4.3) kg m–2 in the HFNC group (n=11) (P=0.23). There was no significant difference in ETO2 or Pao2 at any time during preoxygenation, and all patients reached an ETO2 >0.90 within 5 min. The mean apnoea time was significantly longer (206 [28] vs 43 [12] s; P<0.0001) and Pao2 was lower (38 [12] vs 53 [12] kPa; P=0.013) after intubation in the HFNC group. No patient experienced a SpO2 <100% during intubation. The maximal apnoea time was 264 s owing to a case of unexpected difficult intubation in the HFNC group. Both HFNC and face mask with PEEP provided effective preoxygenation in the morbidly obese. Despite a significantly longer apnoea time and lower post-intubation Pao2 compared with bag-mask ventilation, HFNC maintained SpO2 at 100% throughout the induction and intubation procedure. Nightingale CE, Margarson MP, Shearer E, et al. Anaesthesia 2015; 70: 859–76" @default.
• W3036778727 created "2020-06-25" @default.
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• W3036778727 date "2020-07-01" @default.
• W3036778727 modified "2023-10-14" @default.
• W3036778727 title "Preoxygenation with high-flow nasal cannula versus face mask in morbidly obese patients" @default.
• W3036778727 doi "https://doi.org/10.1016/j.bja.2020.04.033" @default.
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