Arterial oxygen saturation during induction of anaesthesia and laryngeal mask insertion: prospective evaluation of four techniques.
In a prospective, randomized study of 87 patients, we have compared the incidence of hypoxaemia during induction of anaesthesia with subsequent Laryngeal Mask Airway (LMA) insertion in healthy adults when four different techniques were used: one without supplementary oxygen, and three with supplementary oxygen. Twelve patients did not receive supplementary oxygen before LMA placement, 25 underwent partial denitrogenation by breathing oxygen from the start of injection of the induction agent, 25 underwent formal denitrogenation by breathing oxygen for 3 min, and 25 received five tidal volume breaths of oxygen by face mask using positive pressure immediately after induction of anaesthesia. Anaesthesia was induced with propofol 2.0 mg kg-1 and fentanyl 1 microgram kg-1. Additional propofol was given if required. Arterial oxygen saturation was measured by pulse oximetry. Desaturation occurred in 11 of 12 patients who did not receive supplementary oxygen, and in 19 of 25 patients who received manual ventilation with 100% oxygen after induction of anaesthesia before LMA insertion. Full denitrogenation and partial denitrogenation were equally successful in preventing desaturation. Failure to position the LMA successfully occurred in 3% of patients, and some difficulty was encountered in another 18%.
Haynes
S R
SR
Division of Anaesthesia, Victoria Infirmary, Langside, Glasgow.
Allsop
J R
JR
Gillies
G W
GW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D011897:Random Allocation
D010100:Oxygen