Preoxygenation with standard facemask combining apnoeic oxygenation using high flow nasal cannula versuss standard facemask alone in patients with and without obesity: the OPTIMASK international study

Abstract

Background Combining oxygen facemask with apnoeic oxygenation using high-flow-nasal-oxygen (HFNO) for preoxygenation in the operating room has not been studied against standard oxygen facemask alone. We hypothesized that facemask-alone would be associated with lower levels of lowest end-tidal oxygen (EtO2) within 2 min after intubation in comparison with facemask combined with HFNO. Methods In an international prospective before–after multicentre study, we included adult patients intubated in the operating room from September 2022 to December 2022. In the before period, preoxygenation was performed with facemask-alone, which was removed during laryngoscopy. In the after period, facemask combined with HFNO was used for preoxygenation and HFNO for apnoeic oxygenation during laryngoscopy. HFNO was maintained throughout intubation. The primary outcome was the lowest EtO2 within 2 min after intubation. The secondary outcome was SpO2 ≤ 95% within 2 min after intubation. Subgroup analyses were performed in patients without and with obesity. This study was registered 10 August 2022 with ClinicalTrials.gov, number NCT05495841. Results A total of 450 intubations were evaluated, 233 with facemask-alone and 217 with facemask combined with HFNO. In all patients, the lowest EtO2 within 2 min after intubation was significantly lower with facemask-alone than with facemask combined with HFNO, 89 (85–92)% vs 91 (88–93)%, respectively (mean difference − 2.20(− 3.21 to − 1.18), p < 0.001). In patients with obesity, similar results were found [87(82–91)% vs 90(88–92)%, p = 0.004]; as in patients without obesity [90(86–92)% vs 91(89–93)%, p = 0.001)]. SpO2 ≤ 95% was more frequent with facemask-alone (14/232, 6%) than with facemask combined with HFNO (2/215, 1%, p = 0.004). No severe adverse events were recorded. Conclusions Combining facemask with HFNO for preoxygenation and apnoeic oxygenation was associated with increased levels of lowest EtO2 within 2 min after intubation and less desaturation.

Application of Butorphanol versus Sufentanil in Multimode Analgesia via Patient Controlled Intravenous Analgesia After Hepatobiliary Surgery: A Retrospective Cohort Study

“…After a 3-min preoxygenation with 100% oxygen, general anesthesia was induced with an intravenous injection of propofol and sufentanil. 26 , 27 Tracheal intubation or laryngeal mask was facilitated with rocuronium or cis-atracurium. During the operation, combined intravenous-inhalation anesthesia with propofol, remifentanil, and sevoflurane was administered to maintain a BIS of 40 to 60, and adequate muscle relaxation was maintained with intermittent intravenous infusion of cis-atracurium.…”

Noninvasive respiratory support in the perioperative setting: a narrative review

“…Therefore, in the case of rapid sequence induction of anesthesia, THRIVE used for pre-oxygenation could safely extend apnea time during prolonged laryngoscopy and intubation. The administration of HFNO in addition to standard preoxygenation and facemask ventilation is now recommended in high-risk patients ( 22 ).…”