title: Preinduction incentive spirometry versus deep breathing to improve apnea tolerance during induction of anesthesia in patients of abdominal sepsis: A randomized trial.
abstract: BACKGROUND
  Abdominal sepsis is associated with varied degree of hypoxemia and atelactasis in the lung and can enhance the onset of desaturation of arterial blood during apnea.
  
  
  OBJECTIVE
  This study looked at methods to improve safety margin of apnea during induction of anesthesia in these high-risk patients.
  
  
  METHODS
  It was a randomized, single blind study on adult patients presenting for emergency laparotomy due to peritonitis in a university teaching hospital setting.
  
  
  METHODS
  In group 1 (IS) (n = 32), three sessions of incentive spirometry (IS) were performed within one hour before induction of anesthesia. In group 2 (DB) (n = 34), patients were subjected to deep breathing sessions in a similar manner. All patients received preoxygenation (100%) by mask for 3 min, followed by rapid-sequence induction of anesthesia using fentanyl, thiopental, and suxamethonium and endotracheal intubation. Patients were subjected to a period of apnea by keeping the end of the endotracheal tube open to air till they developed 95% hemoglobin saturation (SpO 2) by pulse oxymetry. Positive pressure ventilation was resumed at the end. We observed for hemodynamic changes, apnea time, and SpO 2 (100%) recovery time on resuming ventilation. Arterial blood gas samples were taken before intervention, after IS or DB, after preoxygenation, and at the end of apnea.
  
  
  METHODS
  One-way analysis of variance (ANOVA), X 2 test, Kaplan-Meier graph, and log-rank tests were applied to compare the two study groups.
  
  
  RESULTS
  Oxygenation level in group 1 (265 ± 76.7 mmHg) patients was significantly (P < 0.001) higher than in group 2 (221 ± 61.8 mmHg)at the end of preoxygenation. The apnea time (median: lower bound - upper bound Confidence Interval apnea time) (272:240-279 s) in group 1 (IS) patients was significantly higher P < 0.05) than in group 2 (180:163-209 s) patients. Saturation recovery time (35:34-46 s) in group 1 (IS) patients was also quicker than in group 2 patients (48:44-58 s).
  
  
  CONCLUSIONS
  IS in the preoperative period is superior to deep breathing sessions for improving apnea tolerance during induction of anesthesia in abdominal sepsis patients.
authors.affiliation: Department of Anaesthesiology and Critical Care, BP Koirala Institute of Health Sciences, Dharan, Nepal; Department of Anaesthesiology, SGPG Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, .
authors.forename: M
authors.initials: M
authors.lastname: Tripathi
authors.forename: A
authors.initials: A
authors.lastname: Subedi
authors.forename: A
authors.initials: A
authors.lastname: Raimajhi
authors.forename: K
authors.initials: K
authors.lastname: Pokharel
authors.forename: M
authors.initials: M
authors.lastname: Pandey
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000379:methods*; D001049:Apnea / Q000097:blood / Q000503:physiopathology*; D001945:Breathing Exercises; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage / Q000097:blood*; D010538:Peritonitis / Q000382:microbiology / Q000601:surgery*; D011446:Prospective Studies; D020127:Recovery of Function; D016037:Single-Blind Method; D013147:Spirometry; D013997:Time Factors
chemical_list: D010100:Oxygen