A Volunteer Crossover Feasibility Study to Compare Standard Oxygen Cannula Used at High-Flow to Proprietary High-Flow Humidified Nasal Oxygen Systems.

BACKGROUND AND AIM: Supplemental oxygen is routinely administered to patients prior to and during induction of general anesthesia and sedation. This increases the fraction of oxygen in the lungs, increases oxygen delivery, and increases the time to oxygen desaturation. Proprietary Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) systems, which deliver warmed and humidified oxygen, have been extensively researched in the perioperative and critical care setting and have been shown to significantly prolong time to desaturation and as a means of ventilatory support. The use of traditional nasal oxygen cannula used at maximum flow rates is currently used in short bursts as it is poorly tolerated. There is however a dearth of data examining the use of this technique. We hypothesized that traditional nasal oxygen cannulae used at maximum flow rates can deliver oxygen as effectively as THRIVE in this setting. METHODS: We designed a crossover volunteer feasibility study. The participants were 10 healthy anesthetists. We compared the two methods of oxygen delivery by measuring transcutaneous oxygen measurement and pharyngeal oxygen concentration. Comfort and noise levels were recorded. The aforementioned parameters were compared between the two groups. RESULTS: We observed that a standard oxygen cannula used at high flows delivers comparable oxygen delivery and tissue oxygenation performance to proprietary THRIVE systems. However, they are less comfortable and make more noise. DISCUSSION: To the authors' knowledge this study is the first to study the oxygen delivery of traditional nasal oxygen cannula used at maximum flow rates and make comparisons to the well-studied THRIVE technique. While similar transcutaneous partial pressure of oxygen and pharyngeal gas concentrations were observed with both techniques, the standard cannulae were deemed to be a lot less comfortable than THRIVE and made a lot more noise which likely limit the utility of this technique outside of short bursts. CONCLUSION: In this study, a standard nasal oxygen cannula used at high flows achieved similar oxygen delivery to THRIVE at the expense of poor comfort and increased noise.

Opioid-Free Anesthesia for Lung Cancer Resection: A Case-Control Study.

OBJECTIVE: To assess the feasibility and effectiveness of an opioid-free anesthesia (OFA) technique in lung cancer resection surgery versus standard opioid-based techniques. DESIGN: Retrospective, propensity-matched, case-control study. SETTING: A single, specialty cardiothoracic center between January 2018 and July 2019. PARTICIPANTS: Adult patients undergoing lung cancer resection surgery. INTERVENTIONS: A cohort of 83 patients undergoing an OFA technique (OFA group) for lung cancer resection surgery was matched with 83 patients who underwent similar surgery with a standard anesthesia technique (STD group). Outcome measures compared between the 2 groups included postoperative pain scores at 0, 1, and 24 hours; 24-hour postoperative morphine patient-controlled analgesia consumption; recovery room and hospital lengths of stay; and 30-day all-cause mortality. MEASUREMENT AND MAIN RESULTS: No difference was found in median pain scores (interquartile range [IQR]) at 0 hours: STD 0 (0-1), OFA 0 (0-1); p = 0.48. Median pain scores (IQR) at 1 hour were statistically significantly greater in the STD group compared with the OFA group: STD 1 (0-1), OFA 0 (0-1); p = 0.03. There was no difference in median pain scores (IQR) at 24 hours: STD 0 (0-1), OFA 0 (0-1); p = 0.49. Mean postoperative 24-hour patient-controlled analgesia morphine consumption (standard deviation) was similar between groups: STD 21.1 (±18.8) mg, OFA 16.2 (±18.1) mg; p = 0.16. There was no difference in mean time spent in the postoperative recovery (standard deviation) area between the 2 groups: STD 116 (±49) minutes, OFA 108 (±34) minutes; p = 0.27. Median hospital length of stay (IQR) was longer in the STD group compared with the OFA group: STD 4 (2-6) days, OFA 3 (2-4) days; p = 0.002. CONCLUSIONS: This case-control study demonstrated that an OFA technique in lung cancer resection surgery offers a feasible and safe approach, resulting in similar postoperative pain scores and morphine consumption compared with standard opioid-containing techniques.

The non-steroidal anti-inflammatory drug niflumic acid inhibits Candida albicans growth.

The non-steroidal anti-inflammatory drug niflumic acid was found to inhibit growth of the yeast form of Candida albicans. Niflumic acid inhibited respiratory oxygen uptake and it is hypothesised that this was achieved by cytosolic acidification and block of glycolysis. Inhibitory concentrations are compatible with current practice of topical application.