Preoxygenation With a High-flow Nasal Cannula or a Simple Mask Before General Anesthesia in Head and Neck Surgery
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.
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
Descrição detalhada
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
Tipo de estudo
Inscrição (Real)
Estágio
- Não aplicável
Contactos e Locais
Locais de estudo
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Seoul, Republica da Coréia, 05505
- Jun-Young Jo
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Gêneros Elegíveis para o Estudo
Descrição
Inclusion Criteria:
- Patients with head and neck cancer undergoing resection surgery planned arterial cannulation and invasive arterial blood pressure monitoring and arterial blood gas analysis
- Patients over 19-year old
- Patients who voluntarily participated in the study
- Patents in American Society of Anesthesia physical status 1-3
Exclusion Criteria:
- Patients who don't approve to participation
- Unable to give informed consent because of a language barrier
- Patients with severe respiratory disease
- Patients with severe cardiovascular or cerebrovascular disease
- Patients with severe psychiatric disorders
- Anyone who is not appropriate according to researcher's decision
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
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Experimental: Group N
pre-oxygenation with High-flow nasal cannula
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Apply high flow heated (34 °C) and humidified nasal oxygen with the OptiFlow System (Thrive, Fisher & Paykel®, Aukland New Zealand) using a flow of 30 liter/minute and an inspiratory oxygen fraction (FiO2) of 1.0.
Increase the oxygen flow to 60 liter/minute over the course of the first minute.
Ask the patients not to speak during anesthesia induction and keep the mouth closed.
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Comparador Ativo: Group M
pre-oxygenation with simple mask
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Perform standard preoxygenation by oxygen insufflation via a face mask using the standard anesthesia ventilators (semicircular system) with 100% oxygen flow of 12 liter/minute.
The patients breathe with tidal volume.
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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PaO2 (arterial oxygen partial pressure) at pre-defined time points.
Prazo: through study completion, an average of 10 minutes
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changes of PaO2
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through study completion, an average of 10 minutes
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Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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degree of blood oxygenation oxygenation
Prazo: through study completion, an average of 10 minutes
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result of arterial blood gas analysis
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through study completion, an average of 10 minutes
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various patients' characteristics about airway
Prazo: through study completion, an average of 10 minutes
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upper lip bite test classification (class 1~3)
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through study completion, an average of 10 minutes
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degree of difficulty for intubation
Prazo: through study completion, an average of 10 minutes
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the number of attempts at laryngoscopy and use of any rescue maneuvers, seniority of the anesthesiologist
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through study completion, an average of 10 minutes
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degree of tissue oxygenation
Prazo: through study completion, an average of 10 minutes
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O2 saturation
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through study completion, an average of 10 minutes
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Colaboradores e Investigadores
Patrocinador
Investigadores
- Investigador principal: Seong-Soo Choi, Dr., Department of Anesthesiology and Pain Medicine, Asan Medical Center
Publicações e links úteis
Datas de registro do estudo
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Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
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Outros números de identificação do estudo
- 2019-0275
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