There is no evidence that carbon dioxide-enriched oxygen before apnea affects the time to arterial desaturation, but it might improve cerebral oxygenation in anesthetized obese patients: a single-blinded randomized crossover trial
Abstract Purpose Carbon dioxide (CO2) increases cerebral perfusion. The effect of CO2 on apnea tolerance, such as after anesthesia induction, is unknown. This study aimed to assess if cerebral apnea tolerance can be improved in obese patients under general anesthesia when comparing O2/Air (95%O2) to...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-023-01982-9 |
| _version_ | 1811165770565025792 |
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| author | Marc T. Schmidt Marc Studer Andres Kunz Sandro Studer John M. Bonvini Marco Bueter Lucas Kook Sarah R. Haile Andreas Pregernig Beatrice Beck-Schimmer Martin Schläpfer |
| author_facet | Marc T. Schmidt Marc Studer Andres Kunz Sandro Studer John M. Bonvini Marco Bueter Lucas Kook Sarah R. Haile Andreas Pregernig Beatrice Beck-Schimmer Martin Schläpfer |
| author_sort | Marc T. Schmidt |
| collection | DOAJ |
| description | Abstract Purpose Carbon dioxide (CO2) increases cerebral perfusion. The effect of CO2 on apnea tolerance, such as after anesthesia induction, is unknown. This study aimed to assess if cerebral apnea tolerance can be improved in obese patients under general anesthesia when comparing O2/Air (95%O2) to O2/CO2 (95%O2/5%CO2). Methods In this single-center, single-blinded, randomized crossover trial, 30 patients 18–65 years, with body mass index > 35 kg/m2, requiring general anesthesia for bariatric surgery, underwent two apneas that were preceded by ventilation with either O2/Air or O2/CO2 in random order. After anesthesia induction, intubation, and ventilation with O2/Air or O2/CO2 for 10 min, apnea was performed until the cerebral tissue oxygenation index (TOI) dropped by a relative 20% from baseline (primary endpoint) or oxygen saturation (SpO2) reached 80% (safety abortion criterion). The intervention was then repeated with the second substance. Results The safety criterion was reached in all patients before cerebral TOI decreased by 20%. The time until SpO2 dropped to 80% was similar in the two groups (+ 6 s with O2/CO2, 95%CI -7 to 19 s, p = 0.37). Cerebral TOI and PaO2 were higher after O2/CO2 (+ 1.5%; 95%CI: from 0.3 to 2.6; p = 0.02 and + 0.6 kPa; 95%CI: 0.1 to 1.1; p = 0.02). Conclusion O2/CO2 improves cerebral TOI and PaO2 in anesthetized bariatric patients. Better apnea tolerance could not be confirmed. |
| first_indexed | 2024-04-10T15:41:57Z |
| format | Article |
| id | doaj.art-517ddc8d2b194b44b00e4691059e0b3e |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-04-10T15:41:57Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-517ddc8d2b194b44b00e4691059e0b3e2023-02-12T12:20:33ZengBMCBMC Anesthesiology1471-22532023-02-012311910.1186/s12871-023-01982-9There is no evidence that carbon dioxide-enriched oxygen before apnea affects the time to arterial desaturation, but it might improve cerebral oxygenation in anesthetized obese patients: a single-blinded randomized crossover trialMarc T. Schmidt0Marc Studer1Andres Kunz2Sandro Studer3John M. Bonvini4Marco Bueter5Lucas Kook6Sarah R. Haile7Andreas Pregernig8Beatrice Beck-Schimmer9Martin Schläpfer10Institute of Anesthesiology, University Hospital ZurichSwiss Air ForceSwiss Air ForceClinical Trials Center, University Hospital ZurichInstitute of Anesthesiology, University Hospital ZurichDepartment of Surgery, University Hospital ZurichEpidemiology, Biostatistics and Prevention Institute, University ZurichEpidemiology, Biostatistics and Prevention Institute, University ZurichInstitute of Anesthesiology, University Hospital ZurichInstitute of Anesthesiology, University Hospital ZurichInstitute of Anesthesiology, University Hospital ZurichAbstract Purpose Carbon dioxide (CO2) increases cerebral perfusion. The effect of CO2 on apnea tolerance, such as after anesthesia induction, is unknown. This study aimed to assess if cerebral apnea tolerance can be improved in obese patients under general anesthesia when comparing O2/Air (95%O2) to O2/CO2 (95%O2/5%CO2). Methods In this single-center, single-blinded, randomized crossover trial, 30 patients 18–65 years, with body mass index > 35 kg/m2, requiring general anesthesia for bariatric surgery, underwent two apneas that were preceded by ventilation with either O2/Air or O2/CO2 in random order. After anesthesia induction, intubation, and ventilation with O2/Air or O2/CO2 for 10 min, apnea was performed until the cerebral tissue oxygenation index (TOI) dropped by a relative 20% from baseline (primary endpoint) or oxygen saturation (SpO2) reached 80% (safety abortion criterion). The intervention was then repeated with the second substance. Results The safety criterion was reached in all patients before cerebral TOI decreased by 20%. The time until SpO2 dropped to 80% was similar in the two groups (+ 6 s with O2/CO2, 95%CI -7 to 19 s, p = 0.37). Cerebral TOI and PaO2 were higher after O2/CO2 (+ 1.5%; 95%CI: from 0.3 to 2.6; p = 0.02 and + 0.6 kPa; 95%CI: 0.1 to 1.1; p = 0.02). Conclusion O2/CO2 improves cerebral TOI and PaO2 in anesthetized bariatric patients. Better apnea tolerance could not be confirmed.https://doi.org/10.1186/s12871-023-01982-9Hypoxiaapnea tolerancetissue oxygenationcerebral oxygenation |
| spellingShingle | Marc T. Schmidt Marc Studer Andres Kunz Sandro Studer John M. Bonvini Marco Bueter Lucas Kook Sarah R. Haile Andreas Pregernig Beatrice Beck-Schimmer Martin Schläpfer There is no evidence that carbon dioxide-enriched oxygen before apnea affects the time to arterial desaturation, but it might improve cerebral oxygenation in anesthetized obese patients: a single-blinded randomized crossover trial BMC Anesthesiology Hypoxia apnea tolerance tissue oxygenation cerebral oxygenation |
| title | There is no evidence that carbon dioxide-enriched oxygen before apnea affects the time to arterial desaturation, but it might improve cerebral oxygenation in anesthetized obese patients: a single-blinded randomized crossover trial |
| title_full | There is no evidence that carbon dioxide-enriched oxygen before apnea affects the time to arterial desaturation, but it might improve cerebral oxygenation in anesthetized obese patients: a single-blinded randomized crossover trial |
| title_fullStr | There is no evidence that carbon dioxide-enriched oxygen before apnea affects the time to arterial desaturation, but it might improve cerebral oxygenation in anesthetized obese patients: a single-blinded randomized crossover trial |
| title_full_unstemmed | There is no evidence that carbon dioxide-enriched oxygen before apnea affects the time to arterial desaturation, but it might improve cerebral oxygenation in anesthetized obese patients: a single-blinded randomized crossover trial |
| title_short | There is no evidence that carbon dioxide-enriched oxygen before apnea affects the time to arterial desaturation, but it might improve cerebral oxygenation in anesthetized obese patients: a single-blinded randomized crossover trial |
| title_sort | there is no evidence that carbon dioxide enriched oxygen before apnea affects the time to arterial desaturation but it might improve cerebral oxygenation in anesthetized obese patients a single blinded randomized crossover trial |
| topic | Hypoxia apnea tolerance tissue oxygenation cerebral oxygenation |
| url | https://doi.org/10.1186/s12871-023-01982-9 |
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