Head and Neck Neoplasm Clinical Trial
Official title:
Comparison of Preoxygenation With a High-flow Nasal Cannula and a Simple Mask Before Intubation During Induction of General Anesthesia in Patients Undergoing Head and Neck Surgery
Objectives: To assess arterial oxygen partial pressure (PaO2) at defined time points during
the preoxygenation and to compare between high flow heated humidified nasal oxygen versus
standard preoxygenation with oxygen insufflation via face mask over at least 5 minutes
Methods: This randomized, single-blinded, prospective study was conducted at Asan Medical
Center in Seoul, Republic of Korea.
Populations: Patients undergoing head and neck surgery Expected outcomes: The course of PaO2
levels is superior to those of the face mask during the whole preoxygenation procedure and
after the intubation.
Rationale & background information:
Pre-oxygenation before general anesthesia is usually achieved using oxygen delivered via a
facemask before induction of anesthesia; this potentially extends the time available for
securing the airway before hypoxemia to 6 min. The lungs are commonly ventilated with a
bag/facemask technique after induction, and this can be repeated if attempts at intubating
the trachea are prolonged. However, facemask ventilation has traditionally been avoided in
the circumstance which has the risk of gastric insufflation of gas, leading to increased
intragastric pressure and raised risk of pulmonary aspiration of stomach contents. In
addition, if difficult ventilation is anticipated, facemask ventilation may not be possible
at all, and 6 minutes with hypoxemia may be insufficient for intubation.
An ideal preoxygenation to extend apnea tolerance during anesthesia induction is essential to
avoid live threatening airway incidents. The high-flow nasal cannula, the OptiFlow System
(Thrive, Fisher & Paykel®, Aukland New Zealand), has the ability to deliver warmed and
humidified oxygen through specially designed nasal cannula and enable oxygen to be
comfortably delivered at rates of > 70 liter/min. Several study showed that nasal delivery of
humidified oxygen to paralyzed and anesthetized patients at these rates maintains oxygenation
and achieves acceptable carbon dioxide concentration. The investigators hypothesized that an
extended apneic period without facemask ventilation could be particularly beneficial to
patients undergoing general anaesthesia.
Study goals and objectives:
To assess arterial oxygen partial pressure (PaO2) at defined time points during the
preoxygenation and to compare between high flow heated humidified nasal oxygen versus standard
preoxygenation with oxygen insufflation via face mask over at least 5 minutes
;
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