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Apnoeic oxygenation in morbid obesity: a randomised controlled trial comparing facemask and high-flow nasal oxygen delivery

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Title: Apnoeic oxygenation in morbid obesity: a randomised controlled trial comparing facemask and high-flow nasal oxygen delivery
Authors: Schutzer-Weissmann, J
Wojcikiewicz, T
Karmali, A
Lukosiute, A
Sun, R
Ahmed, A
Purkayastha, S
Brett, S
Cousins, J
Item Type: Journal Article
Abstract: Background Obesity is a risk factor for airway-related incidents during anaesthesia. High flow nasal oxygen has been advocated to improve safety in high-risk groups but its effectiveness in the obese population is uncertain. This study compared the effect of high flow nasal oxygen and low flow facemask oxygen delivery on duration of apnoea in morbidly-obese patients. Methods Patients undergoing bariatric surgery were randomly allocated to receive either high flow nasal (70 L min-1) or facemask (15 L min-1) oxygen. Following induction of anaesthesia, morbidly-obese patients were apnoeic for 18 minutes or until oxygen saturation dropped to 92%. Results Eighty patients were studied (41 high flow nasal oxygen, 39 facemask). Median apnoea duration was 18 minutes in both the high flow nasal oxygen (IQR 18-18 minutes) and the facemask (IQR 4.1-18 minutes) groups. Five patients in the high flow nasal oxygen group and 14 patients in the facemask group desaturated to 92% within 18 minutes. The risk of desaturation was lower in the high flow nasal oxygen group (Hazard Ratio 0.27, 95% CI 0.11-0.65, p=0.007). Conclusions In experienced hands, apnoeic oxygenation is possible in the morbidly-obese and was tolerated for 18 minutes by the majority of patients, whether oxygen delivery was high flow nasal or low flow facemask. High flow nasal oxygen reduced desaturation risk compared to facemask oxygen. Desaturation risk is a more clinically relevant outcome than duration of apnoea. Individual physiological factors are likely to be the primary determinant of risk rather than method of oxygen delivery.
Issue Date: 1-Jan-2023
Date of Acceptance: 8-Dec-2021
URI: http://hdl.handle.net/10044/1/93249
DOI: 10.1016/j.bja.2021.12.011
ISSN: 0007-0912
Publisher: Elsevier
Start Page: 103
End Page: 110
Journal / Book Title: British Journal of Anaesthesia
Volume: 130
Issue: 1
Copyright Statement: © 2021 The Authors. Published by Elsevier Ltd on behalf of British Journal of Anaesthesia. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).
Publication Status: Published
Online Publication Date: 2022-01-11
Appears in Collections:Department of Surgery and Cancer
Faculty of Medicine

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