Supplementation of pre‐oxygenation in morbidly obese patients using nasopharyngeal oxygen insufflation

• Published in: Anaesthesia Vol. 62; no. 8; pp. 769 - 773
• Main Authors: Baraka, A. S., Taha, S. K., Siddik‐Sayyid, S. M., Kanazi, G. E., El‐Khatib, M. F., Dagher, C. M., Chehade, J.‐M. A., Abdallah, F. W., Hajj, R. E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2007; Blackwell
• Subjects: Adult; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bariatric Surgery; Biological and medical sciences; Body Constitution; Body Mass Index; Clinical trials; Female; Humans; Insufflation - methods; Male; Medical sciences; Middle Aged; Nasopharynx; Obesity; Obesity, Morbid - blood; Obesity, Morbid - complications; Obesity, Morbid - surgery; Oxygen; Oxygen - blood; Oxygen Inhalation Therapy - methods; Oxyhemoglobins - metabolism; Preoperative Care - methods; Human; Obesity; Oxygen; Nutrition disorder; Anesthesia; Supplementation; Oxygenation; Nutritional status
• DOI: 10.1111/j.1365-2044.2007.05104.x
• ISSN: 0003-2409

Summary During apnoea following induction of anaesthesia, morbidly obese patients may suffer a rapid decrease in oxygen saturation. This study compares pre‐oxygenation alone with pre‐oxygenation followed by nasopharyngeal oxygen insufflation on the onset of desaturation occurring during the subsequent apnoea. A randomised controlled trial was performed in 34 morbidly obese patients undergoing gastric bypass or gastric band surgery. Seventeen patients received nasopharyngeal oxygen supplementation following pre‐oxygenation (Study group, body mass index = 41.8 (6.9) kg.m−2), and the other 17 patients received pre‐oxygenation alone (Control group, body mass index = 42.7 (5.4) kg.m−2). Time from the onset of apnoea until Spo2 fell to 95% was compared between the two groups with a cut‐off of 4 min. In the control group, the Spo2 fell from 100% to 95% during the subsequent apnoea in 145 (27) s, with a significantly negative correlation (r2 = 0.66, p < 0.05) between the time to desaturation to 95% and the body mass index. In the study group, the Spo2 was maintained in 16 of 17 patients at 100% for 4 min when apnoea was terminated. In conclusion, nasopharyngeal oxygen insufflation following pre‐oxygenation in morbidly obese patients delays the onset of oxyhaemoglobin desaturation during the subsequent apnoea.