RESUMO
BACKGROUND: Obesity is a risk factor for airway-related incidents during anaesthesia. High-flow nasal oxygen has been advocated to improve safety in high-risk groups, but its effectiveness in the obese population is uncertain. This study compared the effect of high-flow nasal oxygen and low-flow facemask oxygen delivery on duration of apnoea in morbidly obese patients. METHODS: Morbidly obese patients undergoing bariatric surgery were randomly allocated to receive either high-flow nasal (70 L min-1) or facemask (15 L min-1) oxygen. After induction of anaesthesia, the patients were apnoeic for 18 min or until peripheral oxygen saturation decreased to 92%. RESULTS: Eighty patients were studied (41 High-Flow Nasal Oxygen, 39 Facemask). The median apnoea time was 18 min in both the High-Flow Nasal Oxygen (IQR 18-18 min) and the Facemask (inter-quartile range [IQR], 4.1-18 min) groups. Five patients in the High-Flow Nasal Oxygen group and 14 patients in the Facemask group desaturated to 92% within 18 min. The risk of desaturation was significantly lower in the High-Flow Nasal Oxygen group (hazard ratio=0.27; 95% confidence interval [CI], 0.11-0.65; P=0.007). CONCLUSIONS: In experienced hands, apnoeic oxygenation is possible in morbidly obese patients, and oxygen desaturation did not occur for 18 min in the majority of patients, whether oxygen delivery was high-flow nasal or low-flow facemask. High-flow nasal oxygen may reduce desaturation risk compared with facemask oxygen. Desaturation risk is a more clinically relevant outcome than duration of apnoea. Individual physiological factors are likely to be the primary determinant of risk rather than method of oxygen delivery. CLINICAL TRIAL REGISTRATION: NCT03428256.
Assuntos
Máscaras , Obesidade Mórbida , Humanos , Máscaras/efeitos adversos , Obesidade Mórbida/terapia , Obesidade Mórbida/complicações , Apneia/terapia , Administração Intranasal , Oxigênio , Oxigenoterapia/efeitos adversosRESUMO
When using a gum elastic bougie, a common device to aid difficult intubations, one must appreciate the significant consequences, be prepared to manage emergency complications, and use safely by advancing under direct vision and using the markings to guide insertion.
Assuntos
Cianose/diagnóstico , Metemoglobinemia/diagnóstico , Mucosa Bucal , Adulto , Butanos/intoxicação , Cianose/tratamento farmacológico , Eletrocardiografia , Inibidores Enzimáticos/uso terapêutico , Feminino , Escala de Coma de Glasgow , Humanos , Metemoglobinemia/tratamento farmacológico , Azul de Metileno/uso terapêutico , Nitratos/intoxicaçãoRESUMO
Peri-implant fractures of the wrist are uncommon, and usually present as stress fractures distal to the site of the implant. We report an unusual case where the radius has fractured beneath a plate, causing bending and deformity of the implant. This prevented reduction of the fracture under sedation, so urgent intervention became necessary due to neurovascular compromise.
