title: [Oxygenation: the impact of face mask coupling.].
abstract: OBJECTIVE
  Different oxygenation techniques aim at promoting denitrogenation before apnea during induction. The main reason why CIO2 = 100% cannot be reached is the lack of adequate face mask coupling, allowing the entry of room air. Although anesthesiologists know this principle, not all of them apply it correctly, facilitating the entry of air in fresh gases flow and consequently diluting CIO2. This prospective study was performed to comparatively evaluate, through the variation of oxygen expired concentration (CEO2), the efficacy of the oxygenation technique via face mask in the conditions routinely used by anesthesiologists, simulating situations of progressive leaks.
  
  
  METHODS
  Oxygen end-tidal concentrations of 15 volunteers, physical status ASA I, were studied with 8 deep breaths (vital capacity) in 60 s with fresh gas flow of 10 L.min-1. The face mask was: tightly fitted with 100% CIO2 (Tf100) or varying from 50% to 90%, (Tf50, Tf60, Tf70, Tf80, Tf90); gravity-coupled to face and 100% CIO2 (Grav) and moved 1 cm away from face with 100% CIO2 (Aw). CEO2 was recorded at 10 s intervals. P < 0.05 was considered statistically significant.
  
  
  RESULTS
  CEO2 has increased for all groups (p < 0.001), but only Tf100 reached values close to ideal (82.20 - 87). Comparing mean CEO2 of Grav and Tf100 at the end of 60s, (82.20 and 65.87) there was a difference of approximately 20% between both techniques, since gravity-coupled mask only did not provide adequate oxygenation. There were no significant differences between groups Tf70 and Grav (65.87 and 62.67) in all studied moments, suggesting that the latter simulates a 70% CIO2 at 60 s. Mean Aw group CEO2 increased to 47.20 at 60s showing that this technique may be associated to unacceptable risk of hypoxemia.
  
  
  CONCLUSIONS
  All situations of face mask coupling gradually increased CEO2, although with decreased oxygenation efficacy due to situations of face mask malposition. This study has shown the need for attention during oxygenation, using well coupled face mask and eliminating normal practices of moved away or gravity-coupled masks.
authors.affiliation: Irmandade da Santa Casa de São Paulo, Hospital Central.
authors.forename: Waldemar Montoya de
authors.initials: WM
authors.lastname: Gregori
authors.forename: Lígia Andrade da Silva Telles
authors.initials: LA
authors.lastname: Mathias
authors.forename: Luiz
authors.initials: L
authors.lastname: Piccinini Filho
authors.forename: Ernesto Leonardo de Carpio
authors.initials: EL
authors.lastname: Pena
authors.forename: Aníbal Heberto Mora
authors.initials: AH
authors.lastname: Vicuna
authors.forename: Joaquim Edson
authors.initials: JE
authors.lastname: Vieira