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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT03671837
Other study ID # STU 022017-074
Secondary ID
Status Completed
Phase N/A
First received
Last updated
Start date July 12, 2017
Est. completion date December 31, 2019

Study information

Verified date March 2020
Source University of Texas Southwestern Medical Center
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This prospective, randomized, double-blind study is intended to enroll a total of 100 patients with a BMI ≥ 40 kg/m2 and another 100 patients with a BMI ≥ 30 kg/m2 (but less than 40 kg/m2) undergoing surgery with general endotracheal anesthesia at Parkland Hospital. Patients will be randomized to receive either 15 L/min O2 or 15 L/min air from a standard nasal cannula during a simulated prolonged laryngoscopy. The anesthesia provider will do a direct laryngoscopy to ensure that the patient has a Cormack-Lehane grade I-II airway. Patients who have grade III-IV airways will be excluded from further study procedures and not analyzed. The rest of the anesthetic will not deviate from the standard of care. Anesthesia providers will be blinded as to whether patients are receiving oxygen or air during the apneic period.


Recruitment information / eligibility

Status Completed
Enrollment 135
Est. completion date December 31, 2019
Est. primary completion date December 31, 2019
Accepts healthy volunteers Accepts Healthy Volunteers
Gender All
Age group 18 Years to 80 Years
Eligibility Inclusion Criteria:

- 18-80 years old

- Obesity (BMI = 30 kg/m2 = 40 kg/m2)

- Morbid obesity (BMI = 40 kg/m2)

- Scheduled for a non-emergent operation that requires general endotracheal anesthesia

- Willing and able to consent in English or Spanish

- No current history of advanced pulmonary or cardiovascular disease

Exclusion Criteria:

- Age less than 18 or older than 70

- BMI < 30 kg/m2

- Patient does not speak English or Spanish

- Family or personal history of malignant hyperthermia

- Patient refusal

- Monitored anesthesia care (MAC) or regional anesthesia planned

- Pregnant or nursing women

- "Stat" (emergent) cases

- Moderate to severe pulmonary disease (e.g., asthma, COPD, pulmonary fibrosis, pulmonary hypertension)

- Respiratory infection within the past 14 days (e.g., pneumonia, bronchitis)

- SpO2 < 97% on room air

- Moderate to severe cardiac disease (e.g., CHF, CAD, aortic stenosis)

- Severe gastroesophageal reflux disease (GERD)

- Nasal obstruction (e.g., tumor)

- Elevated intracranial pressure (e.g., brain tumor)

- History of difficult airway

Study Design


Related Conditions & MeSH terms


Intervention

Other:
Oxygen
15 L/min O2
Air
15 L/min air

Locations

Country Name City State
United States Parkland Health & Hospital System Dallas Texas

Sponsors (1)

Lead Sponsor Collaborator
University of Texas Southwestern Medical Center

Country where clinical trial is conducted

United States, 

References & Publications (16)

Baraka AS, Taha SK, Aouad MT, El-Khatib MF, Kawkabani NI. Preoxygenation: comparison of maximal breathing and tidal volume breathing techniques. Anesthesiology. 1999 Sep;91(3):612-6. — View Citation

Baraka AS, Taha SK, Siddik-Sayyid SM, Kanazi GE, El-Khatib MF, Dagher CM, Chehade JM, Abdallah FW, Hajj RE. Supplementation of pre-oxygenation in morbidly obese patients using nasopharyngeal oxygen insufflation. Anaesthesia. 2007 Aug;62(8):769-73. — View Citation

Campbell IT, Beatty PC. Monitoring preoxygenation. Br J Anaesth. 1994 Jan;72(1):3-4. Erratum in: Br J Anaesth 1994 May;72(5):612. — View Citation

Damia G, Mascheroni D, Croci M, Tarenzi L. Perioperative changes in functional residual capacity in morbidly obese patients. Br J Anaesth. 1988 Apr;60(5):574-8. — View Citation

Dixon BJ, Dixon JB, Carden JR, Burn AJ, Schachter LM, Playfair JM, Laurie CP, O'Brien PE. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Anesthesiology. 2005 Jun;102(6):1110-5; discussion 5A. — View Citation

Don HF, Wahba M, Cuadrado L, Kelkar K. The effects of anesthesia and 100 per cent oxygen on the functional residual capacity of the lungs. Anesthesiology. 1970 Jun;32(6):521-9. — View Citation

Dyett JF, Moser MS, Tobin AE. Prospective observational study of emergency airway management in the critical care environment of a tertiary hospital in Melbourne. Anaesth Intensive Care. 2015 Sep;43(5):577-86. — View Citation

FRUMIN MJ, EPSTEIN RM, COHEN G. Apneic oxygenation in man. Anesthesiology. 1959 Nov-Dec;20:789-98. — View Citation

Heier T, Feiner JR, Lin J, Brown R, Caldwell JE. Hemoglobin desaturation after succinylcholine-induced apnea: a study of the recovery of spontaneous ventilation in healthy volunteers. Anesthesiology. 2001 May;94(5):754-9. — View Citation

Huang KC, Kormas N, Steinbeck K, Loughnan G, Caterson ID. Resting metabolic rate in severely obese diabetic and nondiabetic subjects. Obes Res. 2004 May;12(5):840-5. — View Citation

Jense HG, Dubin SA, Silverstein PI, O'Leary-Escolas U. Effect of obesity on safe duration of apnea in anesthetized humans. Anesth Analg. 1991 Jan;72(1):89-93. — View Citation

Lopez PP, Stefan B, Schulman CI, Byers PM. Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery. Am Surg. 2008 Sep;74(9):834-8. — View Citation

McCahon RA, Hardman JG. Fighting for breath: apnoea vs the anaesthetist. Anaesthesia. 2007 Feb;62(2):105-8. — View Citation

Ramachandran SK, Cosnowski A, Shanks A, Turner CR. Apneic oxygenation during prolonged laryngoscopy in obese patients: a randomized, controlled trial of nasal oxygen administration. J Clin Anesth. 2010 May;22(3):164-8. doi: 10.1016/j.jclinane.2009.05.006. — View Citation

Sakles JC, Mosier JM, Patanwala AE, Dicken JM. Apneic oxygenation is associated with a reduction in the incidence of hypoxemia during the RSI of patients with intracranial hemorrhage in the emergency department. Intern Emerg Med. 2016 Oct;11(7):983-92. doi: 10.1007/s11739-016-1396-8. Epub 2016 Feb 4. — View Citation

Taha SK, Siddik-Sayyid SM, El-Khatib MF, Dagher CM, Hakki MA, Baraka AS. Nasopharyngeal oxygen insufflation following pre-oxygenation using the four deep breath technique. Anaesthesia. 2006 May;61(5):427-30. — View Citation

* Note: There are 16 references in allClick here to view all references

Outcome

Type Measure Description Time frame Safety issue
Primary Apneic Time To determine whether apneic oxygenation via nasal cannula oxygen results in a longer period of apnea (SpO2 = 95%) during a simulated prolonged laryngoscopy in obese and morbidly obese patients. Intraoperative
Secondary Resaturation Time To determine the influence of apneic oxygenation via nasal cannula on the time for resaturation in obese and morbidly obese patients. Intraoperative