Efficacy of different modes of high-flow nasal cannula oxygen in preventing hypoxemia during general anesthesia in obese patients without intubation
10.3760/cma.j.cn131073.20230804.01216
- VernacularTitle:不同模式经鼻高流量吸氧预防肥胖患者非气管插管全麻期间低氧血症的效果
- Author:
Liang WANG
1
;
Xiaoyu LIU
;
Wenrui SHEN
;
Ning YIN
Author Information
1. 南京医科大学附属逸夫医院麻醉科，南京 211100
- Keywords:
Oxygen inhalation therapy;
Obesity;
Noninvasive ventilation;
Hypoxemia
- From:
Chinese Journal of Anesthesiology
2023;43(12):1490-1494
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To assess the efficacy of different modes of high-flow nasal cannula (HFNC) oxygen therapy modes in preventing hypoxaemia during general anesthesia in obese patients without endotracheal intubation.Methods:Eighty-four American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients of either sex, aged 18-64 yr, with body mass index ≥ 30 kg/m 2, undergoing non-intubated general anesthesia surgery, were divided into 3 groups ( n=28 each) by a random number table method: nasal cannula oxygen therapy group (NC group), HFNC oxygen therapy full-course non-pure oxygen group (HFNC1 group) and HFNC oxygen therapy half-course non-pure oxygen group (NHFC2 group). NC group received oxygen through bilateral nasal cannula, and the oxygen flow rate was 5 L/min, and the oxygen flow rate remained unchanged after anesthesia induction. In NHFC1 group, the flow rate was 30 L/min and the FiO 2 was 41%, and the flow rate was adjusted to 60 L/min after anesthesia induction, and the FiO 2 remained unchanged. NHFC2 group received HFNC oxygen inhalation with a flow rate of 30 L/min and FiO 2 100%, and the flow rate was adjusted to 60 L/min and FiO 2 41% after anesthesia induction. Sufentanil 0.1 μg/kg was intravenously injected after 3 min of oxygen pre-inhalation and target effect-site concentration of propofol was 4 μg/ml in open-loop TCI mode, the closed-loop mode was used to continue intravenous infusion of propofol when the BIS value reached 60 with the same target effect-site concentration, and the intraoperative BIS value was maintained at 45-60. The occurrence and total duration of hypoxemia (SpO 2 <92%) and the lowest value of SpO 2 during anesthesia were recorded. Arterial blood gas analysis was performed before anesthesia induction, at 3 min of oxygen pre-inhalation and at 10 min after anesthesia, and PaO 2 and PaCO 2 were recorded. Respiratory interventions and adverse events were recorded. Results:One patient was excluded due to change of anesthesion method in NC group.Compared with NC group, the incidence of hypoxemia was significantly decreased, the total duration of hypoxemia was shortened, the lowest value of SpO 2 was increased, and the usage rate of respiratory intervention methods was decreased, and PaO 2 was increased and PaCO 2 was decreased at 3 min of oxygen pre-inhalation and 10 min after anesthesia in HFNC2 group ( P<0.05), and PaCO 2 was significantly decreased at 3 min of oxygen pre-inhalation, PaO 2 was increased and PaCO 2 was decreased at 10 min after anesthesia ( P<0.05), and no significant change was found in the other parameters in HFNC1 group ( P>0.05). Compared with HFNC1 group, the incidence of hypoxemia was significantly decreased, the total duration of hypoxemia was shortened, the lowest value of SpO 2 was increased, the usage rate of respiratory intervention methods was decreased, and PaO 2 was increased at 3 min of oxygen pre-inhalation in HFNC2 group ( P<0.05). There was no significant difference in adverse events between the three groups ( P>0.05). Conclusions:HFNC in the mode of FiO 2 100% during oxygen pre-inhalation and FiO 2 41% during anesthesia maintenance can reduce the occurrence of hypoxemia during general anesthesia in obese patients without intubation.
