Effect of facemask oxygenation with and without positive pressure ventilation on gastric volume during anesthesia induction in patients undergoing laparoscopic cholecystectomy or partial hepatectomy: a randomized controlled trial.

BACKGROUND: Studies focusing on the relationship between gastric volume and facemask oxygenation without ventilation during apnea in anesthesia induction are scarce. This study compared the change in gastric volume during apnea in anesthesia induction using facemask ventilation and facemask oxygenation without ventilation in adults undergoing laparoscopic surgery. METHODS: In this prospective, randomized, double-blinded trial, 70 adults undergoing laparoscopic surgery under general anesthesia were divided into two groups to receive facemask oxygenation with and without ventilation for 60 seconds after loss of consciousness. Before anesthesia induction and after endotracheal intubation, the gastric antral cross-sectional area was measured with ultrasound imaging. Arterial blood gases were tested at baseline (T1), after preoxygenation (T2), after loss of consciousness (T3), and before and after endotracheal intubation (T4 and T5, respectively). RESULTS: Sixty patients were included (ventilation n = 30; non ventilation n = 30, 10 patients were excluded). The median [IQR] change of gastric antral cross-sectional area in ventilation group was significantly higher than in non ventilation group (0.83 [0.20 to 1.54] vs. 0.10 [- 0.11 to 0.56] cm2, P = 0.001). At T4 and T5, the PaO2 in ventilation group was significantly higher than in non ventilation group (T4: 391.83 ± 61.53 vs. 336.23 ± 74.99 mmHg, P < 0.01; T5: 364.00 ± 58.65 vs. 297.13 ± 86.95 mmHg, P < 0.01), while the PaCO2 in non ventilation group was significantly higher (T4: 46.57 ± 5.78 vs. 37.27 ± 6.10 mmHg, P < 0.01; T5: 48.77 ± 6.59 vs. 42.63 ± 6.03 mmHg, P < 0.01) and the pH value in non ventilation group was significantly lower (T4: 7.35 ± 0.029 vs 7.42 ± 0.047, P < 0.01; T5: 7.34 ± 0.033 vs 7.39 ± 0.044, P < 0.01). At T4, the HCO3- in non ventilation group was significantly higher (25.79 ± 2.36 vs. 23.98 ± 2.18 mmol l- 1, P < 0.01). CONCLUSIONS: During apnoea, the increase in gastric volume was milder in patients undergoing facemask oxygenation without ventilation than with positive pressure ventilation. TRIAL REGISTRATION: ChiCTR2100054193, 10/12/2021, Title: "Effect of positive pressure and non-positive pressure ventilation on gastric volume during induction of general anesthesia in laparoscopic surgery: a randomized controlled trial". Website: https://www.chictr.ogr.cn .

Medium-Flow Oxygenation Through Facial Mask and Nasal Cannula in a Limited Resource Setting.

Introduction: In centers with limited resources, a high flow nasal cannula is not available, thus we assess if preoxygenation with 15L flow of O2 available from anesthesia machines can prolong the safety period of induction of anesthesia before intubation and provide more time for securing the airway. Moreover, we compared the preoxygenation with standard 6L vs. 15L O2 through a facemask or a nasal cannula. Material and methods: Patients were allocated into four groups. Group I patients were preoxygenated with a nasal cannula on 6L of oxygen, patients in group II were preoxygenated with a nasal cannula on 15L of oxygen, patients in group III were preoxygenated with a facemask on 6L of oxygen, and patients in group IV were preoxygenated with a facemask on 15L of oxygen. The primary endpoint was time to desaturation and intubation. The secondary endpoints were PaO2, PaCO2, Sat% and ETCO2. Results: The groups with 15L preoxygenation had a statistically significant prolonged time to desaturation and intubation. Patients allocated to group II have a statistically significant greater PaO2 and lesser ETCO2 compered with group I. However, between patients in group III and IV there is a difference only in PaCO2, and although this effect is significant, both groups have values within the normal range. Conclusion: In centers with limited resources, preoxygenation with the maximum available oxygen flow from anesthesia machines (15L/min) are useful. This prolongs the safety period for securing the airway. We suggest the use of the maximum available amount of oxygen flow from anesthesia machines in clinical settings.