Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden.
Acta Anaesthesiol Scand. 2023 Sep;67(8):1028-1036. doi: 10.1111/aas.14264. Epub 2023 May 10.
Parturients undergoing caesarean section in general anaesthesia have an increased risk of desaturating during anaesthesia induction. Pre- and peri-oxygenation with high-flow nasal oxygen prolong the safe apnoea time but data on parturients undergoing caesarean section under general anaesthesia are limited. This pilot study aimed to investigate the clinical effects and frequency of desaturation in parturients undergoing caesarean section in general anaesthesia pre- and peri-oxygenated with high-flow nasal oxygen and compare this to traditional pre-oxygenation using a facemask.
In this prospective, non-randomised, multi-centre study we included pregnant women with a gestational age ≥30 weeks undergoing caesarean section under general anaesthesia. All parturients were asked to participate in the intervention group consisting of pre-oxygenation using high-flow nasal oxygen. Parturients declining participation were pre-oxygenated with a traditional facemask. Primary outcome was the proportion of parturients desaturating below 93% from start of pre-oxygenation until 1 min after tracheal intubation. Secondary outcomes investigated end-tidal oxygen concentrations after tracheal intubation and the proportion of parturients with signs of regurgitation.
A total of 34 parturients were included, 25 pre- and peri-oxygenated with high-flow nasal oxygen and 9 pre-oxygenated with facemask. No difference in patient or airway characteristics could be seen except for a higher BMI in the high-flow nasal oxygen group (31.4 kg m [4.7] vs. 27.7 kg m [3.1]; p = .034). No woman in any of the two groups desaturated below 93%. The lowest peripheral oxygen saturation observed, in any parturient, was 97%. There was no difference detected in end-tidal oxygen concentration after tracheal intubation, 87% (6) in the high-flow nasal oxygen group vs 80% (15) in the facemask group (p = .308). No signs of regurgitation, in any parturient, were seen.
Pre- and peri-oxygenation with high-flow nasal oxygen maintain adequate oxygen saturation levels during induction of anaesthesia also in parturients. Regurgitation of gastric content did not occur in any parturient and no other safety concerns were observed in this pilot study.
全身麻醉下行剖宫产术的产妇在麻醉诱导期间有饱和度降低的风险增加。高流量鼻氧预充和围充可延长安全无通气时间，但有关全身麻醉下行剖宫产术产妇的数据有限。本研究旨在探讨全身麻醉下行剖宫产术产妇预充和围充高流量鼻氧的临床效果和饱和度降低的发生率，并与传统面罩预充进行比较。
在这项前瞻性、非随机、多中心研究中，我们纳入了孕周≥30 周且全身麻醉下行剖宫产术的孕妇。所有产妇均被要求参与预充高流量鼻氧的干预组。拒绝参与的产妇采用传统面罩预充。主要结局是从预充开始到气管插管后 1 分钟内饱和度降低至 93%以下的产妇比例。次要结局为气管插管后呼气末氧浓度和有反流迹象的产妇比例。
共纳入 34 例产妇，其中 25 例预充和围充高流量鼻氧，9 例预充面罩。除高流量鼻氧组 BMI 较高（31.4kg·m-2[4.7]比 27.7kg·m-2[3.1]；p=0.034）外，患者和气道特征无差异。两组均无产妇饱和度降至 93%以下。任何产妇的最低外周血氧饱和度均为 97%。气管插管后呼气末氧浓度无差异，高流量鼻氧组为 87%（6），面罩组为 80%（15）（p=0.308）。任何产妇均无反流迹象。
高流量鼻氧预充和围充可在全身麻醉诱导期间维持产妇的氧饱和度水平。本研究中，无产妇出现胃内容物反流，也未观察到其他安全性问题。
