AK-316.2.1 Apneic oxygenation as an innovative technique of respiratory
support in reconstructive tracheal surgery
A. Alekseev, M. Vyzhigina, V. Titov, V. Parshin
Moskau
Recently, apneic oxygenation (AO) became a popular technique among
anaesthesiologists in tracheal surgery. Despite the fact that there are many studies
on the use of AO [1], the subject of the application of this technique in the tracheal
surgery is still discussed. Some authors believe that the duration of AO should be
limited to 10-15 minute due to emerging respiratory acidosis and increase the level
of PaCO2 [2], while others report about the successful application of AO for 75
minutes. [3] Objective: to study the parameters of the gas composition, acid-base
status of arterial blood, hemodynamics and ECG in patients who received AO on
the main stage of reconstructive surgery on the trachea. Patients and Methods:
The study included 28 patients with stenotic tracheal disease who underwent
reconstructive surgery on the trachea using the AO as a method of respiratory
support at the main stage of the operation. In most patients, the duration AO varied
from 10 to 20 minutes, in 5 patients AO was used for 30 minutes, in 4 patients for
40 minutes. In 25 patients the catheter was placed above the bifurcation of the
trachea, in 3 in the top right bronchus. In all patients we measured parameters of
PO2, PCO2, pH, BE and HCO3- of arterial blood. These parameters were
recorded during the implementation phase of surgical approach and conventional
mechanical ventilation (FiO2 = 1.0), every 10, 20, 30 and 40 minutes of AO use
during main stage of operation, and 20 minutes after the return to conventional
ventilation (FiO2 = 0.5) . Additionally we recorded data of ECG, invasive blood
pressure, heart rate and pulse oximetry by monitor. Results: We found a
respiratory acidosis and hyperoxia in all patients. The parameters of heart rate,
blood pressure and ECG were within the normal range for all described modes of
respiratory support. Conclusions: The AO may be used as one of the alternative
methods of respiratory support for tracheal surgery. Catheter for AO can be
installed above the bifurcation of the trachea, and in the main bronchus. The main
limitation is hypercapnia and respiratory acidosis, which, however, was not
accompanied with haemodynamic disorders.
References:
1. Alekseev A.V., Vyzhigina M.A., Parshin V.D., Fedorov D.S. Apneic
oxygenation. Anesteziol Reanimatol. 2013 Sept-Oct;(5):69-74. (in Russian)
2. G. Edward Morgan Jr., Maged S. Mikhail Clinical anesthesiology: 2nd book –
Translation from English. – M.: BINOM, 2008; 182 (in Russian)
3. Jiménez, M.J. Sadurní, M. Tió, M. Rovira, I. Fita, G. Martínez, E. Gimferrer,
J.M. Gomar, C. Macchiarini, P. Apnoeic oxygenation in complex tracheal
surgery: O-58. Eur J Anaesthesiol. 2006 May; Vol. 23 – suppl. 38: p. 20.
Anästh Intensivmed 2015;56:S126
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