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Journal of Anesthesia

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01-04-2011 | Original Article

Preoxygenation with 20º head-up tilt provides longer duration of non-hypoxic apnea than conventional preoxygenation in non-obese healthy adults

Authors: Venkateswaran Ramkumar, Goneppanavar Umesh, Frenny Ann Philip

Published in: Journal of Anesthesia | Issue 2/2011

Abstract

Purpose

Failed airway is the anesthesiologist’s nightmare. Although conventional preoxygenation can provide time, atelectasis occurs in the dependent areas of the lungs immediately after anesthetic induction. Therefore, alternatives such as positive end-expiratory pressure (PEEP) and head-up tilt during preoxygenation have been explored. We compared the conventional preoxygenation technique (group C) with 20º head-up tilt (group H) and 5 cmH₂O PEEP (group P) in non-obese individuals for non-hypoxic apnea duration.

Methods

A total of 45 patients were enrolled (15 in each group). After 5 min of preoxygenation, intubation was performed after induction of anesthesia with thiopentone and succinylcholine. After confirming the tracheal intubation by esophageal detector device and capnogram, all patients were administered vecuronium to maintain neuromuscular blockade and midazolam to prevent awareness. Post-induction, patients in all groups were left apneic in supine position with the tracheal tube exposed to atmosphere till the SpO₂ dropped to 93% or 10 min of safe apnea was achieved.

Results

The demographic data were comparable. Non-hypoxic apnea duration was higher with group H (452 ± 71 s) compared to group C (364 ± 83 s, P = 0.030). Group P did not show significant increase in the duration of non-hypoxic apnea (413 ± 86 s). There were no adverse outcomes or events.

Conclusions

Preoxygenation is clinically and statistically more efficacious and by inference more efficient in the 20º head-up position than with conventional technique in non-obese healthy adults. Although application of 5 cmH₂O PEEP provides longer duration of non-hypoxic apnea compared to conventional technique, it is not statistically significant.

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Title: Preoxygenation with 20º head-up tilt provides longer duration of non-hypoxic apnea than conventional preoxygenation in non-obese healthy adults
Authors: Venkateswaran Ramkumar
Goneppanavar Umesh
Frenny Ann Philip
Publication date: 01-04-2011
Publisher: Springer Japan
Published in: Journal of Anesthesia / Issue 2/2011
Print ISSN: 0913-8668
Electronic ISSN: 1438-8359
DOI: https://doi.org/10.1007/s00540-011-1098-3

At a glance: The STEP trials

Springer Medicine

Preoxygenation with 20º head-up tilt provides longer duration of non-hypoxic apnea than conventional preoxygenation in non-obese healthy adults

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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