Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnami-si, Gyeonggi-do, 13496, Korea.
Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Korea.
BMC Anesthesiol. 2020 Nov 10;20(1):282. doi: 10.1186/s12871-020-01201-9.
Airway management is a part of routine anesthetic procedures; however, serious complications, including hypoxia and death, are known to occur in cases of difficult airways. Therefore, alternative techniques such as fiberoptic bronchoscope-assisted intubation (FOB intubation) should be considered, although this method requires more time and offers a limited visual field than does intubation with a direct laryngoscope. Oxygen insufflation through the working channel during FOB intubation could minimize the risk of desaturation and improve the visual field. Therefore, the aim of this prospective randomized controlled study was to evaluate the utility and safety of oxygen insufflation through the working channel during FOB intubation in apneic patients.
Thirty-six patients were randomly allocated to an N group (no oxygen insufflation) or an O group (oxygen insufflation). After preoxygenation, FOB intubation was performed with (O group) or without (N group) oxygen insufflation in apneic patients. The primary outcome was the velocity of decrease in the partial pressure of oxygen (PaO) during FOB intubation (V, mmHg/sec) defined as the difference of PaO before and after intubation divided by the time to intubation. The secondary outcomes included the success rate for FOB intubation, time to intubation, visual field during FOB intubation, findings of arterial blood gas analysis, and occurrence of FOB intubation-related complications.
We found that V was significantly greater in the N group than in the O group (1.0 ± 0.4 vs. 0.4 ± 0.4; p < 0.001), while the visual field was similar between groups. There were no significant intergroup differences in the secondary outcomes.
These findings suggest that oxygen insufflation through the working channel during FOB intubation aids in extending the apneic window during the procedure.
ClinicalTrials.gov , NCT02625194 , registered at December 9, 2015.
气道管理是常规麻醉程序的一部分；然而，在困难气道的情况下，已知会发生严重并发症，包括缺氧和死亡。因此，应考虑使用纤维支气管镜辅助插管（FOB 插管）等替代技术，尽管这种方法比直接喉镜插管需要更多的时间并且提供的视野有限。在 FOB 插管期间通过工作通道进行氧气吹入可以最大限度地降低低氧血症的风险并改善视野。因此，本前瞻性随机对照研究的目的是评估在无通气患者中通过 FOB 插管的工作通道进行氧气吹入的实用性和安全性。
36 名患者被随机分配到 N 组（无氧气吹入）或 O 组（氧气吹入）。在预充氧后，在无通气患者中进行 FOB 插管，在 O 组中进行（O 组）或不进行（N 组）氧气吹入。主要结局是 FOB 插管期间氧分压（PaO）下降速度（V，mmHg/sec），定义为插管前后 PaO 的差值除以插管时间。次要结局包括 FOB 插管成功率、插管时间、FOB 插管期间的视野、动脉血气分析结果以及 FOB 插管相关并发症的发生情况。
我们发现 N 组的 V 明显大于 O 组（1.0±0.4 与 0.4±0.4；p<0.001），而两组之间的视野相似。次要结局无显著组间差异。
这些发现表明，在 FOB 插管期间通过工作通道进行氧气吹入有助于在手术过程中延长无通气窗口。
ClinicalTrials.gov，NCT02625194，于 2015 年 12 月 9 日注册。
