BJA Advance Access originally published online on September 2, 2005
British Journal of Anaesthesia 2005 95(5):706-709; doi:10.1093/bja/aei231
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Pre-oxygenation in the obese patient: effects of position on tolerance to apnoea
Departamento de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
* Corresponding author. E-mail: falterma{at}med.puc.cl
Background. In obese patients, reduced functional residual capacity exacerbated by supine position might decrease the effectiveness of pre-oxygenation and the tolerance to apnoea. The aim of this study was to compare the effect of body posture during pre-oxygenation, sitting or supine, on its effectiveness in obese patients.
Methods. Forty obese patients (BMI 
35 kg m–2) undergoing surgery with general anaesthesia were randomly assigned to one of two groups: Group 1 (sitting, n=20) or Group 2 (supine, n=20). In the predetermined body position, pre-oxygenation was achieved with eight deep breaths within 60 s and an oxygen flow of 10 litre min–1. After rapid sequence induction of anaesthesia in decubitus position, the trachea was intubated and the patient was left apneic and disconnected from the anaesthesia circuit until SpO2 decreased to 90%. The time taken for desaturation to 90% from the end of induction of anaesthesia was recorded. Arterial blood oxygen tension was measured before (baseline) and after pre-oxygenation. Values were compared with two-way ANOVA and unpaired Student's t-test.
Results. Oxygen and carbon dioxide tensions were similar between groups, both at baseline and after pre-oxygenation. However, the mean time to desaturation to 90% was significantly longer in the sitting group compared with the supine group [mean (SD): 214 (28) vs 162 (38) s, P<0.05].
Conclusions. Pre-oxygenation in sitting position significantly extends the tolerance to apnoea in obese patients when compared with the supine position.
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