A STUDY OF EFFECTS OF VARYING DURATIONS OF PREOXYGENATION ON PERIPHERAL OXYGEN SATURATION IN PATIENTS UNDERGOING ELECTIVE SURGERIES UNDER GENERAL ANESTHESIA

Main Article Content

Dr. V. Vijaya Lakshmi
Dr. V. Madhu Priya
Dr. E. Lokeswara Reddy
Dr. G. Sarada

Keywords

Pre-oxygenation, Peripheral Oxygen Saturation, Elective Surgeries, General Anesthesia

Abstract

Background: In this study, we wanted to study the comparison of the effects of different periods of pre-oxygenation on peripheral oxygen saturation (SpO2), to find out the optimal duration of pre-oxygenation.


 Methods: This was a prospective, randomised, double-blind, controlled study that was carried out over a period of one-year in the Department of Anesthesiology and Critical Care Medicine at ACSRGMC, Nellore, involving 75 ASA I and 2 physical status patients who were posted for elective surgeries. The patients were in the age range of 20 to 50 years. The study was approved by the institutional ethics committee, and the participant’s gave written informed consent.


 Results: All of the GROUPs had similar demographics. The mean SpO2 levels after one minute of apnoea were 97.44±2.95 in GROUP A, 98.20±2.59 in GROUP B, and 99.96 ± 0.20in GROUP C, comparable between GROUPs A, B but revealed a significant difference between GROUPs A and B. The difference in SPO2 between GROUP B, C and GROUP A, C suggests that the drop in saturation in GROUP A, B was significant compared to GROUP C. The mean PR in GROUP A was 107.16 ±10.71, which was significantly higher than the mean pulse rates in GROUP B, C which were 101.04 ± 7.55and 99.24 ± 9.02, respectively and, GROUP B, C scores were substantially closer to baseline levels. Based on our findings, pre oxygenation for five minutes protects against saturation drops better than pre oxygenation for three minutes or 1 minute.


 Conclusion: The best way to pre-oxygenate is to use the Magill circuit and tidal volume breathing technique for five minutes. Moreover, pre-oxygenation significantly postpones by three and a half minutes the commencement of apnea-induced decrease in peripheral oxygen saturation during tidal volume breathing.

Abstract 58 | pdf Downloads 36

References

1. Baraka A, Ramez Salem M, Benumof’s airway management. 2nd edn. Mosby Elsevier Publications 2007:303-12.
2. Benumof JL. Pre-oxygenation: best method for both efficacy and efficiency? The Journal of the American Society of Anesthesiologists 1999 Sep 1;91(3):603-5.
3. Practice guidelines for management of difficult airway. An updated report by American Society of Anaesthesiologists Task Force on management of difficult airway. Anaesthesiol 2003;98:1269-77.
4. Berthoud M, Read DH, Norman J. Pre-oxygenation-how long? Anaesthesia 1983;38:103-7.
5. Taha S, Khatib MEI, Sayyid SS, Dagher C, Chehade MJ, Baraka A. Pre-oxygenation with the Mapleson D system requires higher oxygen flows than Mapleson A or circle systems. Can J Anesth 2007;54(2):141-5.
6. Campbell IT, Beatty PC. Monitoring pre-oxygenation. Br J Anaesth 1994;72(1):3-4.
7. Lane S, Saunders D, Schofield A, Padmanabhan R, Hildreth A, Laws D. A prospective, randomized controlled trial comparing the efficacy of pre- oxygenation in 20 degree head-up v/s supine position. Anaesthesia 2005;60(11):1064-7.
8. Gagnon C, Fortier LP, Donati F. When a leak is unavoidable, pre-oxygenation is equally ineffective with vital capacity or tidal volume breathing. Can J Anesth 2006;53(1):86-91.
9. Ooi R, Joshi P, Soni N. A high flow semi-open system for pre- oxygenation: an evaluation. Br J Anaesth 1992;68(1):39-42.
10. Pre-oxygenation: physiology and practice. Lancet 1992;339(8784):31-2.
11. Taha SK, Siddik‐Sayyid SM, El‐Khatib MF, Dagher CM, Hakki MA, Baraka AS. Nasopharyngeal oxygen insufflation following pre‐oxygenation using the four deep breath technique. Anaesthesia 2006;61(5):427-30.
12. Sanjay OP, Raipet MA. Use of pulse-oximeter to study the effects of varying durations of pre-oxygenation. Indian J Anaesth 2004;48(3):201-3.
13. Baraka AS, Taha SK, Aouad MT, El-Khatib MF, Kawkabani NI. Pre-oxygenation: comparison of maximal breathing and tidal volume breathing techniques. Anesthesiology 1999;91(3):612-6.
14. Nimmagadda U, Chiravuri SD, Salem MR, Joseph NJ, Wafai Y, Crystal GJ et al. Pre-oxygenation with tidal volume and deep breathing techniques: the impact of duration of breathing and fresh gas flow. Anesth Analg 2001;92(5):1337-41.
15. McCarthy G, Elliott P, Mirakhur RK, McLoughlin C. A comparison of different pre-oxygenation techniques in the elderly. Anaesthesia 1991;46(10):824-7