Key result
Difficult ventilation, intubation, and preoxygenation are linked to the ~7% hypoxaemia rate during anesthesia induction.
Why the study?
The incidence of hypoxaemia related to airway management during induction of anaesthesia after standardised preoxygenation remains a concern and requires identification of contributing risk factors.
Observational (n=2,398)
Yes
Difficult mask ventilation, difficult tracheal intubation, and difficult preoxygenation are significant risk factors for hypoxaemia during anaesthesia induction, highlighting the need for improved preoxygenation techniques in daily practice.
Difficult mask ventilation or intubation was associated with higher hypoxaemia risk after preoxygenation; leaves open whether targeted strategies reduce incidence in high-risk patients.
Abtsract Background The incidence of hypoxaemia related to airway management is still a matter of concern. Our aim was to determine the factors that contribute to hypoxaemia during induction of anaesthesia after a standardised preoxygenation procedure. Methods The study was a multicentre and prospective observational trial. It evaluated the incidence of hypoxaemia at induction of anaesthesia in adult patients. The primary endpoint was the incidence of hypoxaemia defined as pulse oximetry of arterial oxyhaemoglobin saturation (SpO 2 ) <95%. Results Of 2398 patients, hypoxaemia was observed in 158 (6.6%). We identified five preoperative independent risk factors: chronic obstructive pulmonary disease, hypertension, anticipated difficult mask ventilation and difficult tracheal intubation, and emergency surgery. There were also three pre-induction independent risk factors: difficult preoxygenation, difficult mask ventilation, and difficult tracheal intubation. We found a high negative predictive value of preoperative risk factors for difficult mask ventilation of 0.96 (0.95–0.96), and for difficult tracheal intubation (0.95 [0.94–0.96]). A total of 723 patients (30%) experienced difficult preoxygenation (FeO 2 <90% at the end of preoxygenation). Male sex, chronic obstructive pulmonary disease, hypertension, emergency surgery, and predictable difficult mask ventilation were independent patient risk factors for difficult preoxygenation. Conclusions Difficult mask ventilation and difficult tracheal intubation are risk factors for hypoxaemia at induction of general anaesthesia. Difficult preoxygenation was observed in 30% of patients and was also identified as a risk factor for hypoxaemia. This suggests that techniques improving preoxygenation should be implemented in daily practice.
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Baillard et al. (2018) conducted an observational in Hypoxaemia during induction of anaesthesia (n=2,398). Preoperative and pre-induction risk factors (e.g., difficult mask ventilation, difficult tracheal intubation, difficult preoxygenation) was evaluated on Incidence of hypoxaemia defined as pulse oximetry of arterial oxyhaemoglobin saturation (SpO2) <95%. Hypoxaemia occurred in 6.6% of patients during induction of anaesthesia, with difficult mask ventilation, difficult tracheal intubation, and difficult preoxygenation identified as independent risk factors.
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