Details
Category: Volume 08 Issue 01 January 2020
Hits: 1122

Title: Comparison of two Methods of Preoxygenation in Elderly Patients Undergoing Surgery under General Anaesthesia

Authors: Pradipta Kumar Patel, Sumati Kandi, Dumini Soren, Smita Nayak

 DOI: https://dx.doi.org/10.18535/jmscr/v8i1.118

Abstract

Background and Aims: Preoxygenation is performed routinely as an integral part of induction for general anaesthesia to reduce the risk of hypoxia for planned or unplanned periods of apnoea during the induction of anaesthesia. 3-5 minutes of tidal volume preoxygenation is the most preferred technique of choice for preoxygenation. This technique may not be feasible in emergency situations. Faster method of preoxygenation may be more useful and a better alternative in certain clinical conditions like rapid sequence induction, life saving emergencies etc. This study aims to compare the effectiveness between  two methods of preoxygenation i.e. 8 vital capacity breath (VCB) in 1 minute and Tidal volume breathing (TVB) for 3 minutes and in elderly patients, by assessing changes in arterial oxygen tension (PaO2)and apneoa induced desaturation time.

Material and Methods: This prospective randomised controlled double blind study was conducted with 60 elderly patients (age 60-70 yrs)  and  were divided into 2 groups-Group VCB and Group TVB. After preoxygenation with either method, anaesthesia was induced in all patients. Mask ventilation was not done and following intubation endotracheal tube was kept open to atmosphere. The time taken for the patients to desaturate to 90% was noted and immediately ventilation was resumed. Arterial blood gas samples were taken while patients were breathing room air, immediately after preoxygenation and at 90% desaturation.

Results: After preoxygenation group VCB had significant higher PaO2 values than group TVB( 451.50 ± 68.57 vs  400.19 ± 63.69). The apnoea induced desaturation time for group VCB was  494.77 ± 18.92 secs and group TVB was 506.67 ± 22.70 secs, which was statistical insignificant.

Conclusion: The eight vital capacity breath technique may be used as an alternative to the traditional technique of preoxygenation in elderly patients undergoing rapid- sequence induction of anaesthesia, as well as in other emergency situations.

Keywords: Preoxygenation, Vital capacity breath, Tidal volume breath.

References

  1. Cook TM, Woodall N, Frerk C: Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth 2011; 106: 617-31.
  2. Valentine SJ, Marjot R, Monk CR. Preoxygenation in the elderly: a comparison of the four-maximal-breath and three-minute techniques. Anesth Analg 1990; 71:516.
  3. Gold MI, Durate I, Muravchik S. Arterial oxygenation in conscious patients after 5 minutes and after 30 seconds of oxygen breathing. Anesth Analg 1981; 60: 313-5.
  4. Baraka AS, Taha SK, Aouad MT, El-Khatib MF, Kawkabani NI. Preoxygenation: comparison of maximal breathing and tidal volume breathing techniques. Anesthesiology 1999; 91: 612-6.
  5. Davies GA, Bolton CE. Age related changes in respiratory system. In: Fillit HM, Rockwood K, Woodhouse KW, eds. Philadelphia, PA: Saunders Elsevier. Brockhurst’s Text Book of Geriatric Medicine and Gerontology, 7th ed. 2010:97–100.
  6. Wahba WM. Influence of aging on lung function—clinical significance of changes from age twenty. Anesth Analg. 1983;62:764–776.
  7. Benumof JL, Dagg R, Benumof R: Critical hemoglobin desaturation will occur before return to an unparalyzed state following 1 mg/kg intravenous succinylcholine. Anesth 1997; 87: 979–82.
  8. McCarthy G, Elliott P, Mirakhur RK, McLoughlin C. A comparison of different pre-oxygenation techniques in the elderly. Anaesthesia. 1991;46:824–827.
  9. Nimmagadda U, Chiravuri SD, Salem MR, Joseph NJ, Wafai Y, Crystal GJ et al. Preoxygenation with tidal volume and deep breathing techniques: the impact of duration of breathing and fresh gas flow. Anesth Analg 2001; 92: 1337-41.
  10. Rooney MJ. Pre-oxygenation: A comparison of two techniques using a Bain system. Anaesthesia. 1994;49:629-632.
  11. Gambee AM, Hertzka RE, Fisher DM. Preoxygenation techniques: Comparison of three minutes and four breaths. Anesthesia and Analgesia. 1987;66:468-470.
  12. Eggers J, Paley HW, Leonard JJ, Warren JV. Hemodynamic responses to oxygen breathing in man. J Appl Physiol. 1962;17:75–79.
  13. Drummond GB, Park GR. Arterial oxygen saturation before intubation of the trachea. British Journal of Anaesthesia 1984; 56: 987-93.
  14. 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.
  15. Dr Balwinderjit Singh, Dr Lalita, Afzal, Dr Balwinderjit Kaur, Dr Narjeet kaur. Comparison of pre-oxygenation by maximal breathing and tidal volume breathing techniques. IJA 2006; 50(3): 209-14.
  16. Taha SK, El-Khatib MF, Siddik-Sayyid SM, et al. Preoxygenation by 8 deep breaths in 60 seconds using the Mapleson A (Magill), the circle system, or the Mapleson D system. J Clin Anesth 2009; 21:574.
  17. J Khandrani, A Modak, B Pachpande, G Walsinge, A Ghosh. Study Of Effects Of Varying Durations Of Pre-Oxygenation.The Internet Journal of Anesthesiology. 2008 Volume 20 Number 1.
  18. Prashant R Ginimuge, Ranjan RK, Ambarasha M. Preoxygenation: Comparison of three techniques. Anesthesia. 2009; 25: 436-8.
  19. Perry JJ, Lee JS, Sillberg VA, et al. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev. 2008;(2): CD002788.

Corresponding Author

Dr Sumati Kandi

Assistant Professor, Deptt. of Anaesthesiology, VSSIMSAR, Burla, Sambalpur, Odisha – 768017, India