From the Department of Anaesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul (J-EC, J-YH), College of Medicine, Kangwon University, Chuncheon, Republic of Korea (J-EC), Department of Anaesthesiology & Pain Medicine, Sheikh Khalifa Specialty Hospital, RAK, United Arab Emirates (TS) and College of Medicine, Seoul National University, Seoul, Republic of Korea (TS, J-YH).
Eur J Anaesthesiol. 2021 Aug 1;38(8):825-830. doi: 10.1097/EJA.0000000000001473.
Airway management is more challenging in the obese. Compared with the supine position, the sitting position can decrease the collapsibility of the upper airway and improve respiratory mechanics.
The aim of this study was to evaluate the 25° semisitting position on the effectiveness of mask ventilation in anaesthetised paralysed obese patients.
A randomised, cross-over study.
Medical centre managed by a university tertiary hospital.
Thirty-eight obese adults scheduled for general anaesthesia.
After anaesthesia and paralysis, two-handed mask ventilation was performed in the supine and 25° semi-sitting positions with a cross-over, in a randomised order. During mask ventilation, mechanical ventilation was delivered with a pressure-controlled mode with a peak inspiratory pressure of 15 cmH2O, a respiratory rate of 15 bpm, and no positive end-expiratory pressure. Ventilatory outcomes were based upon lean body weight.
Exhaled tidal volume (ml kg-1), respiratory minute volume (ml kg-1 min-1), and the occurrence of inadequate ventilation, defined as an exhaled tidal volume less than 4 ml kg-1, or absence of end-tidal CO2 recording.
Exhaled tidal volume (mean ± SD) in the 25° semi-sitting position was higher than in the supine position, 9.3 ± 2.7 vs. 7.6 ± 2.4 ml kg-1; P less than 0.001. Respiratory minute volume was improved in the 25° semisitting position compared with that in the supine position, 139.6 ± 40.7 vs. 113.4 ± 35.7 ml kg-1 min-1; P less than 0.001.
The 25° semisitting position improved mask ventilation compared with the supine position in anaesthetised paralysed obese patients.
ClinicalTrials.gov (NCT03996161).
气道管理在肥胖患者中更具挑战性。与仰卧位相比，坐位可以降低上气道的塌陷程度并改善呼吸力学。
本研究旨在评估在麻醉瘫痪肥胖患者中，25°半坐位对面罩通气效果的影响。
随机交叉研究。
由大学附属医院管理的医疗中心。
38 名拟全身麻醉的肥胖成年人。
麻醉和瘫痪后，在仰卧位和 25°半坐位以交叉方式随机顺序进行双手面罩通气。在面罩通气期间，机械通气采用压力控制模式，吸气峰压为 15cmH2O，呼吸频率为 15bpm，无呼气末正压。通气结果基于去脂体重。
呼出潮气量（ml/kg）、呼吸分钟通气量（ml/kg/min）和通气不足的发生情况，定义为呼出潮气量小于 4ml/kg 或无呼气末二氧化碳记录。
25°半坐位的呼出潮气量（平均值±标准差）高于仰卧位，分别为 9.3±2.7ml/kg 和 7.6±2.4ml/kg；P 小于 0.001。与仰卧位相比，25°半坐位呼吸分钟通气量改善，分别为 139.6±40.7ml/kg/min 和 113.4±35.7ml/kg/min；P 小于 0.001。
在麻醉瘫痪肥胖患者中，25°半坐位较仰卧位可改善面罩通气。
ClinicalTrials.gov（NCT03996161）。
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