Résumé
Objective:To systematically review and evaluate the safety and efficacy of high-flow nasal oxygen (HFNO) for pre-oxygenation before anesthesia induction.Methods:Pubmed, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database and China Biomedical Literature Database were searched from inception to March 2022.All randomized controlled trials comparing HFNO and facemask ventilation for pre-oxygenation before anesthesia induction were collected.Two researchers independently assessed the quality of trials and extracted data.The primary outcome was the safe apnea time, the secondary outcomes were the lowest SpO 2 during intubation, oxygenation-related complications, patient comfort, PaO 2 and PaCO 2 before and after pre-oxygenation and after intubation.Meta-analysis was performed using RevMan 5.4 software. Results:Seventeen randomized controlled trials involving 843 patients were included in this meta-analysis.The results of meta-analysis showed that the safe apnea time was significantly longer ( MD=67.61, 95% CI 5.94-129.28, P=0.03), the lowest SpO 2 was higher during tracheal intubation ( MD=3.27, 95% CI 2.25-4.29, P<0.01), and PaO 2 was higher after pre-oxygenation ( MD=54.39, 95% CI 9.32-99.46, P=0.02) in the patients using HFNO than those using facemask ventilation.There were no statistically significant differences in the other outcomes ( P>0.05). Conclusions:HFNO for pre-oxygenation before anesthesia induction can significantly prolong the safe apnea time, increase the lowest SpO 2 during tracheal intubation, and improve the levels of PaO 2 after pre-oxygenation, and HFNO does not affect the patient′s comfort or increase the development of preoxygenation-related complications when compared with facemask ventilation.
Résumé
Introducción: Es aún controversial la conducta anestésica de los pacientes tratados por toracoscopia para tratamiento quirúrgico de las hiperhidrosis en los miembros superiores. Objetivos: Identificar el comportamiento de los niveles de oxigenación y del dióxido de carbono al final de la espiración, así como los posibles efectos adversos al aplicar la técnica de Oxigenación Apneica en pacientes que se les realizará simpatectomía transtorácica endoscópica T2-T3. Material y Método: Se realizó un estudio descriptivo, transversal en 16 pacientes a los que se les aplicó la oxigenación apneica empleando tubo orotraqueal convencional. En el intraoperatorio se midió el tiempo de apnea por hemitórax y se evaluó la saturación periférica arterial de oxigeno (SpO2) y el dióxido de carbono al final de la espiración (etCO2), además de la frecuencia cardiaca (FC) y la tensión arterial no invasiva (TA). Resultados: a pesar de los tiempos de apnea la oxigenación se mantuvo óptima en todos los casos, el valor medio del etCO2 no supera los 60 mmHg y no se encontraron cambios significativos de la FC y TA con respecto a los valores basales. Conclusiones: La técnica de Oxigenación Apneica es útil en este tipo de procedimiento.
Even now it is arguable the anesthetic behavior of patients underwent thoracoscopy for a surgical treatment of hyperhidrosis of upper extremities. Objectives: To identify the behavior of oxygenation and carbon dioxide (CO2 ) at the end of the exhalation, as well as the potential side effects with the application of apneic oxygenation in patients in which a T2-T3 endoscopic transthoracic sympathectomy will be carried out. Material and Methods: A cross-sectional and descriptive study was conducted in 16 patients underwent apneic oxygenation using a conventional orotracheal tube. At intraoperative period the apnea time was measured by hemithorax and the arterial peripheral oxygen saturation (Sp02) was assessed and the carbon dioxide at the end of the exhalation (etCO2), as well as the heart rate (HR) and the non-invasive blood pressure (BP). Results: Despite the apnea times the oxygenation remained optimal in all the cases, the mean value of etCO2 in under the 60 mmHg without significant changes of HR and the BP regarding the basal values. Conclusions: The apneic oxygenation technique is useful in this type of procedure.