The Effects of Intraoperative Inspired Oxygen Fraction on Postoperative Pulmonary Parameters in Patients with General Anesthesia: A Systemic Review and Meta-Analysis

Koo, Chang Hoon; Park, Eun Young; Lee, Sun Young; Ryu, Jung Hee

doi:10.3390/jcm8050583

Cited by 21 publications

(16 citation statements)

References 36 publications

(72 reference statements)

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“…The patients' Vt and RR during spontaneous breathing can meet the needs of intraoperative oxygenation, even in LMA anesthesia with 50% oxygen. Koo et al concluded that an oxygen concentration of 50% could decrease the risk of atelectasis caused by high oxygen concentration [19]. Our results showed that all patients maintained their SpO 2 at good level during the operation, including three patients whose preoperative SpO 2 was lower than 93%.…”

Section: Discussionsupporting

confidence: 54%

Feasibility of laryngeal mask anesthesia combined with nerve block in adult patients undergoing internal fixation of rib fractures: a prospective observational study

et al. 2020

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Background: The laryngeal mask airway (LMA) is occasionally used in internal fixation of rib fractures. We evaluated the feasibility of general anesthesia with an LMA associated to a thoracic paravertebral block (TPB) and/or an erector spinae plane block (ESPB) for internal fixation of rib fractures. Methods: Twenty patients undergoing unilateral rib fracture fixation surgery were enrolled. Each patient received general anesthesia with an LMA combined with TPB and/or ESPB, which provided a successful blocking effect. All patients received postoperative continuous analgesia (PCA) with 500 mg of tramadol and 16 mg of lornoxicam, and intravenous injection of 50 mg of flurbiprofen twice a day. Our primary outcomes including the partial pressure of arterial oxygen (PaO 2) and arterial carbon dioxide (PaCO 2) were measured preoperatively and on the first day after surgery. Secondary outcomes including the vital signs, ventilation parameters, postoperative numerical rating scale (NRS) pain scores, the incidence of postoperative nausea and vomiting (PONV), perioperative reflux and aspiration, and nerve block-related complications were also evaluated. Results: Thirteen men and seven women (age 35-70 years) were enrolled. Six (30%) had a flail chest, nine (45%) had hemothorax and/or pneumothorax, and two (10%) had pulmonary contusions. The postoperative PaO 2 was higher than the preoperative value (91.2 ± 16.0 vs. 83.7 ± 15.9 mmHg, p = 0.004). The preoperative and postoperative PaCO 2 were 42.1 ± 3.7 and 43.2 ± 3.7 mmHg (p = 0.165), respectively. Vital signs and spontaneous breathing were stable during the surgery. The end-tidal carbon dioxide concentrations (EtCO 2) remained within an acceptable range (≤ 63 mmHg in all cases). NRS at T1, T2, and T3 were 3(2,4), 1(1,3), and 0(0,1), respectively. None had PONV, regurgitation, aspiration, and nerve block-related complications. Conclusions: The technique of laryngeal mask anesthesia combined with a nerve block was feasible for internal fixation of rib fractures.

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Section: Discussionsupporting

confidence: 54%

Feasibility of laryngeal mask anesthesia combined with nerve block in adult patients undergoing internal fixation of rib fractures: a prospective observational study

et al. 2020

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“…High Fio 2 should be particularly directed to treatment or prevention of hypoxemia (e.g., preintubation and preextubation), and avoidance of Fio 2 of 1.0 might be most beneficial intraoperatively to patients at high risk for atelectasis. 212…”

Section: Inspired Fraction Of Oxygenmentioning

confidence: 99%

Perioperative Pulmonary Atelectasis: Part II. Clinical Implications

et al. 2021

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The development of pulmonary atelectasis is common in the surgical patient. Pulmonary atelectasis can cause various degrees of gas exchange and respiratory mechanics impairment during and after surgery. In its most serious presentations, lung collapse could contribute to postoperative respiratory insufficiency, pneumonia, and worse overall clinical outcomes. A specific risk assessment is critical to allow clinicians to optimally choose the anesthetic technique, prepare appropriate monitoring, adapt the perioperative plan, and ensure the patient’s safety. Bedside diagnosis and management have benefited from recent imaging advancements such as lung ultrasound and electrical impedance tomography, and monitoring such as esophageal manometry. Therapeutic management includes a broad range of interventions aimed at promoting lung recruitment. During general anesthesia, these strategies have consistently demonstrated their effectiveness in improving intraoperative oxygenation and respiratory compliance. Yet these same intraoperative strategies may fail to affect additional postoperative pulmonary outcomes. Specific attention to the postoperative period may be key for such outcome impact of lung expansion. Interventions such as noninvasive positive pressure ventilatory support may be beneficial in specific patients at high risk for pulmonary atelectasis (e.g., obese) or those with clinical presentations consistent with lung collapse (e.g., postoperative hypoxemia after abdominal and cardiothoracic surgeries). Preoperative interventions may open new opportunities to minimize perioperative lung collapse and prevent pulmonary complications. Knowledge of pathophysiologic mechanisms of atelectasis and their consequences in the healthy and diseased lung should provide the basis for current practice and help to stratify and match the intensity of selected interventions to clinical conditions.

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“…Koo CH concluded the oxygen concentration of 50% could decrease the risk of atelectasis which was caused by high oxygen concentration. 14 Our results showed that all patients kept their SpO 2 at 99.1±1.3%…”

Section: Resultsmentioning

confidence: 51%

Observational study for laryngeal mask anesthesia combined with nerve block in internal fixation for rib fractures

Cao

Zhang

Gao

et al. 2020

Preprint

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Background: General anesthesia with endotracheal intubation always has been considered mandatory for rib fractures surgery. Recently, there has been interestng in nonintubated technique of LMA anesthesia for lung surgery. We developed a protocol with laryngeal mask(LMA) anesthesia combined with nerve block for rib fractures surgery, and performed it in several cases prospectively. Methods: Twenty patients undergoing unilateral rib fractures surgery were enrolled. Thoracic paravertebral block(TPB) and/or erector spinae plane block(ESPB) were carried out before LMA anesthesia. The vital signs(HR, BP, SpO 2 ) and parameters of breath were gathered during the operation. The arterial blood gas analysis and chest film were performed preoperatively and on the next day after operation. All patients received postoperative continous analgesia pump contained with 500mg of tramadol and 16mg of lornoxicam after the operation, and intravenous 50mg flurbiprofen Bisindie in the ward. Postoperative nausea and vomiting(PONV) within 48 hours after surgery and NRS pain scoreat 6(T1), 12(T2), 24(T3) hours after surgery were assessed as well. We also recorded the incidence of perioperative reflux, aspiration and nerve block complications. Results: Thirteen males and seven females(mean age 54 years) were enrolled in this trial. 6(30%) had a flail chest, 9(45%) had haemothorax, 2(10%) had pulmonary contusion. The vital signs and spontaneous breathing were kept stable. End-tidal carbon dioxide concentrations(EtCO 2 ) were in an acceptable range(no more than 63 mmHg in all cases). The mean value of postoperative PaO 2 was increased than that of preoperative PaO 2 (91.2±16.0 vs. 83.7±15.9 mmHg, P=0.004). The mean value of preoperative and postoperative PaCO 2 was(42.1±3.7 vs. 43.2±3.7mmHg, P=0.165) respectively. Postoperative NRS at T1, T2, T3 was (3±1, 2±2, 0) respectively. No one suffered from PONV. In addition, perioperative reflux, aspiration and nerve block complications didn't appear in all cases. Conclusions: The technique of laryngeal mask anesthesia combined with nerve block was feasible in the internal fixation for rib fractures.

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The Effects of Intraoperative Inspired Oxygen Fraction on Postoperative Pulmonary Parameters in Patients with General Anesthesia: A Systemic Review and Meta-Analysis

Cited by 21 publications

References 36 publications

Feasibility of laryngeal mask anesthesia combined with nerve block in adult patients undergoing internal fixation of rib fractures: a prospective observational study

Feasibility of laryngeal mask anesthesia combined with nerve block in adult patients undergoing internal fixation of rib fractures: a prospective observational study

Perioperative Pulmonary Atelectasis: Part II. Clinical Implications

Observational study for laryngeal mask anesthesia combined with nerve block in internal fixation for rib fractures

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