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VOLUME 8 , ISSUE 2 ( July-December, 2023 ) > List of Articles

Original Article

Comparison of Efficacy of Preoxygenation by Conventional Method vs Conventional Plus Supplementation via Nasal Prongs at Two Different Flow Rates

Shrividya Chellam, Pritee H Bhirud, Sandeep Satheesan, Pratibha V Toal

Keywords : End-tidal oxygen, Nasal prongs, Preoxygenation

Citation Information : Chellam S, Bhirud PH, Satheesan S, Toal PV. Comparison of Efficacy of Preoxygenation by Conventional Method vs Conventional Plus Supplementation via Nasal Prongs at Two Different Flow Rates. Res Inno Anesth 2023; 8 (2):38-43.

DOI: 10.5005/jp-journals-10049-2035

License: CC BY-NC 4.0

Published Online: 29-12-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aim: To compare the efficacy of preoxygenation by a commonly used conventional method of preoxygenation, that is, tidal volume breathing of 100% oxygen (O2) for 3 minutes, with preoxygenation with the conventional method and supplementary O2 supply via nasal prongs at two different flow rates. Objectives: Primary objective evaluation of EtO2 following three different methods of preoxygenation, that is, • 3 minutes of tidal volume breathing through a closed circuit and a well-fitting anesthesia face mask with 100% O2 at a flow rate of 12 L/minutes. • 3 minutes of above plus supplementary O2 supply via nasal prongs at 3 L/minute. • 3 minutes of above plus supplementary O2 supply via nasal prongs at 10 L/minute. Secondary objective: To evaluate patient comfort using the three different preoxygenation techniques. Materials and methods: In this prospective, observational, comparative cross-over study 110 patients were included. Each participant fulfilling the inclusion criteria then underwent three different methods of preoxygenation, that is, • 3 minutes tidal volume breathing through a closed circle system with a well-fitted anesthesia face mask and valve completely open at a flow rate of 12 L/minute. • 3 minutes of the above plus supplementary O2 via nasal prongs at 3 L/minute. • 3 minutes of the above plus supplementary O2 via nasal prongs at 10 L/minute. • The patients were asked to assess the comfort levels associated with each method. Results: There was a statistically significant difference from baseline EtO2 with each of the methods (p < 0.001), implying all three methods increased the O2 reserve in the lung when compared with the baseline levels. Among the methods, method A produced 3.77 times higher EtO2 levels than method B [95% CI (2.54, 5.006) and p < 0.001]. Method C EtO2 levels are 10.26 times > method B [95% CI (11.22, 9.298) and p < 0.001] and 6.48 times higher than EtO2 of method A (95% CI (5.72, 7.24) and p < 0.001], implying method C produced best preoxygenation amongst all the methods. Conclusion: Preoxygenation with the conventional method at 12 L/minute and conventional method supplemented with the nasal cannula at 3 L/minutes and 10 L/minute is efficacious in providing preoxygenation. The use of a nasal cannula at a flow rate of 3 L/minute, along with conventional preoxygenation, can cause a reduction in EtO2 as compared to conventional method alone. Preoxygenation is enhanced by nasal cannula at 10 L/minute, but the same should be titrated against the comfort of the patient. Nasal prongs are available in most patient care areas; therefore, this simple, noninvasive, inexpensive technique could be routinely incorporated with airway management at a flow rate of 10/minute to enhance preoxygenation.


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