Pre-oxygenation by facemask or high-flow nasal oxygen.

Eur J Anaesthesiol

From the Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK (AJG) and Hospital Morales Meseguer, Murcia, Spain (AME).

Published: January 2020

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http://dx.doi.org/10.1097/EJA.0000000000001039DOI Listing

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Article Synopsis
  • High-flow nasal oxygenation improves oxygenation during anaesthesia induction for pregnant women with obesity, but its effects compared to standard facemask ventilation were studied due to a lack of existing data.
  • A clinical trial involving 54 participants revealed that those using high-flow nasal oxygen had significantly higher oxygen levels after pre-oxygenation compared to the facemask group.
  • While high-flow nasal oxygen showed improved oxygenation results, the differences weren’t deemed clinically significant, suggesting it could be a viable option for these patients.
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Background: There are concerns that airway management in patients with suspected or confirmed cervical spine injury may exacerbate an existing neurological deficit, cause a new spinal cord injury or be hazardous due to precautions to avoid neurological injury. However, there are no evidence-based guidelines for practicing clinicians to support safe and effective airway management in this setting.

Methods: An expert multidisciplinary, multi-society working party conducted a systematic review of contemporary literature (January 2012-June 2022), followed by a three-round Delphi process to produce guidelines to improve airway management for patients with suspected or confirmed cervical spine injury.

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Introduction: Before tracheal intubation, it is essential to provide sufficient oxygen reserve for emergency patients with full stomachs. Recent studies have demonstrated that high-flow nasal oxygen (HFNO) effectively pre-oxygenates and prolongs apneic oxygenation during tracheal intubation. Despite its effectiveness, the use of HFNO remains controversial due to concerns regarding carbon dioxide clearance.

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Background: Patients suffering from major traumatic injuries frequently require emergency anaesthesia. Due to often compromised physiology and the time-sensitive management, trauma patients may be more prone to desaturate during induction of anaesthesia. We hypothesised that pre-oxygenation using high-flow nasal oxygen would decrease the risk of desaturation during induction of anaesthesia in trauma patients and the study therefore aimed to compare the frequency of desaturation when pre-oxygenation was performed with high-flow nasal oxygen or a traditional facemask.

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Effectiveness of Face mask only oxygenation and apnoeic oxygenation in addition to face mask in sustaining PaO during rapid sequence induction - A randomized control trial.

J Anaesthesiol Clin Pharmacol

February 2023

Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pillaiyarkuppam, Puducherry, India.

Background And Aims: Apnoeic oxygenation, although useful during elective intubations, has not shown consistent beneficial results during emergency intubations in critically ill patients. We aimed to study the effectiveness of adding apnoeic oxygenation to our routine practice of using facemask alone, in emergency laparotomy patients needing rapid sequence induction (RSI), for sustaining partial pressure of oxygen (PaO).

Material And Methods: Seventy-two patients undergoing RSI for emergency laparotomy were randomly allocated to either receive pre-oxygenation with 5 L/min of oxygen (O) with a facemask (Group-FM) or apnoeic oxygenation with 10 L/min of O through a nasal catheter in addition to pre-oxygenation (Group-NC).

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