High flow nasal cannula oxygen preventing deoxygenation during induction of general anaesthesia in caesarean section: A randomized controlled trial

Osman, Yasser Mohamed; El-Raof, Rehab Abd

doi:10.1016/j.tacc.2021.06.006

Cited by 9 publications

(32 citation statements)

References 27 publications

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“…After duplicate and ineligible studies were removed, 14 RCTs with a total of 1012 participants were finally included in our systematic review and meta-analysis (Fig. 1 ) [ 13 – 19 , 21 – 24 , 27 – 29 ]. The characteristics of included studies are presented in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…When comparing the safe apnoea time, the included articles have different definitions. Two defined from the cessation of spontaneous breathing until the SpO 2 decreased to 90% or the apnoea time reached 6 min or 10 min [ 13 , 14 ], one defined the apnoea time from the onset of cessation of breathing until the SpO 2 decreased to 95% or the apnoea time reached 6 min [ 21 ] and one defined from the cessation of spontaneous breathing until the SpO 2 decreased to 92% [ 18 ]. And there are also differences in the definition of deoxysaturation, desaturation was defined as SpO 2 ≦90% in two studies [ 22 , 23 ], SpO 2 ≦93% in two studies [ 15 , 24 ] and SpO 2 ≦92% in one study [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

“…However, it was based on small-sampled studies and did not restrict the control group to standard face mask ventilation. In addition, recent published RCTs can be included in our systematic and meta-analysis [ 13 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the effectiveness of high-flow nasal oxygen vs. standard facemask oxygenation for pre- and apneic oxygenation during anesthesia induction: a systematic review and meta-analysis

et al. 2022

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Background In recent years, high flow nasal oxygen (HFNO) has been widely used in clinic, especially in perioperative period. Many studies have discussed the role of HFNO in pre- and apneic oxygenation, but their results are controversial. Our study aimed to examine the effectiveness of HFNO in pre- and apneic oxygenation by a meta-analysis of RCTs. Methods EMBASE, PUBMED, and COCHRANE LIBRARY databases were searched from inception to July 2021 for relevant randomized controlled trails (RCTs) on the effectiveness of HFNO versus standard facemask ventilation (FMV) in pre- and apenic oxygenation. Studies involving one of the following six indicators: (1) Arterial oxygen partial pressure (PaO2), (2) End expiratory oxygen concentration (EtO2), (3) Safe apnoea time, (4) Minimum pulse oxygen saturation (SpO2min), (5) Oxygenation (O2) desaturation, (6) End expiratory carbon dioxide (EtCO2) or Arterial carbon dioxide partial pressure(PaCO2) were included. Due to the source of clinical heterogeneity in the observed indicators in this study, we adopt random-effects model for analysis, and express it as the mean difference (MD) or risk ratio (RR) with a confidence interval of 95% (95%CI). We conducted a risk assessment of bias for eligible studies and assessed the overall quality of evidence for each outcome. Results Fourteen RCTs and 1012 participants were finally included. We found the PaO2 was higher in HFNO group than FMV group with a MD (95% CI) of 57.38 mmHg (25.65 to 89.10; p = 0.0004) after preoxygenation and the safe apnoea time was significantly longer with a MD (95% CI) of 86.93 s (44.35 to 129.51; p < 0.0001) during anesthesia induction. There were no significant statistical difference in the minimum SpO2, CO2 accumulation, EtO2 and O2 desaturation rate during anesthesia induction between the two groups. Conclusions This systematic review and meta-analysis suggests that HFNO should be considered as an oxygenation tool for patients during anesthesia induction. Compared with FMV, continuous use of HFNO during anesthesia induction can significantly improve oxygenation and prolong safe apnoea time in surgical patients.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Comparison of the effectiveness of high-flow nasal oxygen vs. standard facemask oxygenation for pre- and apneic oxygenation during anesthesia induction: a systematic review and meta-analysis

et al. 2022

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“…[ 8 , 15 , 16 , 22 ] Two studies recruited healthy pregnant women who required tracheal intubation for elective cesarean section. [ 20 , 23 ]…”

Section: Resultsmentioning

confidence: 99%

“…Four studies evaluated obese patients for surgery [8,15,16,22] . Two studies recruited healthy pregnant women who required tracheal intubation for elective cesarean section [20,23] …”

Section: Resultsmentioning

confidence: 99%

A comparison of high-flow nasal cannula and standard facemask as pre-oxygenation technique for general anesthesia

Kuo

Liu

et al. 2022

Medicine

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Background: Current practice guidelines recommend the use of nasal cannula as an alternative pre-oxygenation method for tracheal intubation. However, the efficacy of high-flow nasal oxygenation versus standard facemask oxygenation has not been fully evaluated.Methods: We searched PubMed, Cochrane Library, and ClinicalTrials.gov for English-language studies published from January 1, 2000 to November 30, 2021. We included randomized controlled trials which compared high-flow nasal oxygenation and facemask oxygenation as the pre-oxygenation maneuver. Primary outcome was arterial partial pressure of oxygen (PaO 2 ) after preoxygenation. Secondary outcomes were safe apnea time, arterial desaturation during intubation, lowest peripheral capillary oxygen saturation during intubation, and patient comfort score. Random-effects models and Mantel-Haenszel method were used for data synthesis.Results: A total of 16 randomized controlled trials and 1148 patients were included. High-flow nasal oxygenation achieved a higher PaO 2 compared with facemask, mean difference: 64.86 mm Hg (95% confidence interval [CI]: 32.33-97.40, P < .0001). Safe apnea time was longer in high-flow nasal oxygenation, mean difference: 131.03 seconds (95% CI: 59.39-202.66, P < .0001). There was no difference in the risk of peri-intubation desaturation or lowest peripheral capillary oxygen saturation between groups. Patient comfort score was higher in high-flow nasal oxygenation, mean difference: 1.00 (95% CI: 0.46-1.54, P = .0003).Conclusion: High-flow nasal oxygenation better enhanced PaO 2 and extended safe apnea time and is not inferior to facemask oxygenation in preventing desaturation during tracheal intubation. High-flow nasal oxygenation may be considered as an alternative method, especially for patients with a potential difficult airway.Abbreviations: CI = confidence interval, FMO = facemask oxygenation, GA = general anesthesia, HFNO = high-flow nasal oxygenation, PaO 2 = arterial partial pressure of oxygen, PEEP = positive end-expiratory pressure, PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-analyses, RR = risk ratio, SpO 2 = peripheral capillary oxygen saturation.

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Oxygenation during the apnoeic phase preceding intubation in adults in prehospital, emergency department, intensive care and operating theatre environments

White

Vlok

Thang

et al. 2023

Cochrane Database of Systematic Reviews

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High flow nasal cannula oxygen preventing deoxygenation during induction of general anaesthesia in caesarean section: A randomized controlled trial

Cited by 9 publications

References 27 publications

Comparison of the effectiveness of high-flow nasal oxygen vs. standard facemask oxygenation for pre- and apneic oxygenation during anesthesia induction: a systematic review and meta-analysis

Comparison of the effectiveness of high-flow nasal oxygen vs. standard facemask oxygenation for pre- and apneic oxygenation during anesthesia induction: a systematic review and meta-analysis

A comparison of high-flow nasal cannula and standard facemask as pre-oxygenation technique for general anesthesia

Oxygenation during the apnoeic phase preceding intubation in adults in prehospital, emergency department, intensive care and operating theatre environments

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