Preoxygenation with 208 head-up tilt provides longer duration of non-hypoxic apnea than conventional preoxygenation in non-obese healthy adults

Ramkumar, Venkateswaran and Goneppanavar, Umesh and Philip, Frenny Ann (2011) Preoxygenation with 208 head-up tilt provides longer duration of non-hypoxic apnea than conventional preoxygenation in non-obese healthy adults. Journal of Anesthesia, 25 (2). pp. 189-194.

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Abstract

Purpose: Failed airway is the anesthesiologist’s nightmare. Although conventional preoxygenation can provide time, atelectasis occurs in the dependent areas of the lungs immediately after anesthetic induction. Therefore, alternatives such as positive end-expiratory pressure (PEEP) and head-up tilt during preoxygenation have been explored. We compared the conventional preoxygenation technique (group C) with 208 head-up tilt (group H) and 5 cmH2O PEEP (group P) in non-obese individuals for non-hypoxic apnea duration. Methods: A total of 45 patients were enrolled (15 in each group). After 5 min of preoxygenation, intubation was performed after induction of anesthesia with thiopentone and succinylcholine. After confirming the tracheal intubation by esophageal detector device and capnogram, all patients were administered vecuronium to maintain neuromuscular blockade and midazolam to prevent awareness. Post-induction, patients in all groups were left apneic in supine position with the tracheal tube exposed to atmosphere till the SpO2 dropped to 93% or 10 min of safe apnea was achieved. Results: The demographic data were comparable. Non-hypoxic apnea duration was higher with group H (452 ± 71 s) compared to group C (364 ± 83 s, P = 0.030).Group P did not show significant increase in the duration of non-hypoxic apnea (413 ± 86 s). There were no adverse outcomes or events. Conclusions: Preoxygenation is clinically and statistically more efficacious and by inference more efficient in the 208 head-up position than with conventional technique in nonobese healthy adults. Although application of 5 cmH2O PEEP provides longer duration of non-hypoxic apnea compared to conventional technique, it is not statistically significant.

Item Type: Article
Uncontrolled Keywords: Preoxygenation � Apnea � PEEP � Head-up tilt
Subjects: Medicine > KMC Manipal > Anaesthesiology
Depositing User: KMC Manipal
Date Deposited: 10 Sep 2012 06:24
Last Modified: 10 Sep 2012 06:24
URI: http://eprints.manipal.edu/id/eprint/77160

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