Effectiveness of Preoxygenation With Positive Airway Pressure: a Comparison of the Supine and 25° Head up Position

B.P. Koirala Institute of Health Sciences

Status: Completed

Conditions: Intubation;Difficult

Treatments: Other: head-up position; Other: 5 cmH2O CPAP

Study type: Interventional

Funder types: Other

Identifiers

NCT03861949

IERB/205/014

Details and patient eligibility

About

Several techniques such as positive airway pressure and head-up tilt during preoxygenation have shown to prolong non-hypoxic apnea period compared to conventional technique. However, uniform recommendations have not yet been made. Therefore, in the present study the investigators attempted to find out the effect of combination of 5 cmH2O CPAP and 25° head up position during preoxygenation.

Full description

In this study 60 non-obese healthy adult patients were divided into three groups; Group C receiving preoxygenation in conventional technique, Group S receiving preoxygenation with 5 cmH2O CPAP and Group H receiving preoxygenation in 25° head-up position with 5 cmH2O CPAP. After 3 min of preoxygenation, anesthesia was induced and trachea intubated. After confirming the tracheal intubation by direct visualization, all patients were left apneic in supine position with the tracheal tube exposed to atmosphere till the SpO2 dropped to 92%. The primary outcome compared between the groups was the non-hypoxic apnoeic period (time to fall SpO2 to 92%).

Enrollment: 60 patients

Sex: All

Ages: 18 to 60 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• adult patients of ASA physical status I and II undergoing surgery under general anaesthesia

Exclusion criteria

• anticipated difficult mask ventilation/ intubation
• individuals with significant cardiorespiratory or cerebrovascular disease
• pregnant ladies
• patient with history of epilepsy
• body mass index >25 kg/m2
• hemoglobin <8 gm/dL
• patients who were non-ambulant for >24 h, having SpO2 < 97% while breathing in room air
• phobia to facemask.

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

---

60 participants in 3 patient groups

Conventional

No Intervention group

Description:

preoxygenation done with 100% oxygen in supine position

Positive-pressure

Experimental group

Description:

preoxygenation done with 5 cmH2O CPAP (continuous positive airway pressure) in supine position with 100% oxygen

Treatment:

Other: 5 cmH2O CPAP

Head-up

Experimental group

Description:

preoxygenation done in 25 degree head-up position with 5 cmH2O CPAP with 100% oxygen

Treatment:

Other: 5 cmH2O CPAP

Other: head-up position