If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".
Electronic Letters to:
|
|
E-letters: Electronic letters published:
-
![[Read E-letter]](/icons/misc/sectionDOWN.gif)
Optimum Positioning for Preoxygenation: Offer the Benefits to All
- David I Saunders (30 November 2005)
-
Re: Pre-oxygenation in obese patients
- Marcelo Sperandio Ramos (9 November 2005)
-
Pre-oxygenation in obese patients
- Sunil Kannanparambil (21 October 2005)
|
|
|||
|
David I Saunders, Consultant Anaesthetist Royal Perth Hospital, Perth, Western Australia
Send letter to journal:
|
Dear Sir I read with interest the article by Drs Altermatt et al (1), who showed that in their group of obese patients, pre-oxygenation in the sitting position, followed by a supine rapid sequence induction, permitted a longer period of apnoea before desaturation than when pre-oxygenation had been performed with the patient supine. I should like to draw the reader's attention to a similar and perhaps more generally applicable paper (2). In this study we were able to demonstrate a prolonged mean time to desaturation during apnoea following non-rapid sequence induction of anaesthesia, from 283s to 386s, in a group of non-obese female patients who were pre-oxygenated and induced in a position of 20 degrees head-up as opposed to being supine (p=0.002). We found no significant alteration in haemodynamic variables, nor any increase in difficulty of laryngoscopy between the two groups. Similarly, in the extremely obese patient, Dixon et al (3) have recently demonstrated that a 25 degree head-up position during pre- oxygenation provides an improved apnoea time compared to the supine position. I suggest that the benefits of pre-oxygention in the 20 degree head- up position should not be reserved for the obese patient, and that by permitting induction and intubation in the same position as for pre- oxygenation, the 20 degree head-up position is more comfortable for both patient and anaesthetist alike. 1 Altermatt FR, Munoz HR, Delfino AE, et al. Pre-oxygenation in the obese patient: effects of position on tolerance to apnoea. Br J Anaesth 95 (5): 706-9 2 Lane S, Saunders D, Schofield A, et al. A prospective randomised controlled trial comparing efficacy of pre-oxygenation in the 20 degree head-up vs supine position. Anaesthesia 2005; 60: 1064-67 3 Dixon BJ, Dixon JB, Carden JR, et al. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomised controlled study. Anesthesiology 2005; 102: 1110-5 Conflict of Interest:co-author of related paper |
|||
|
|
|||
|
Marcelo Sperandio Ramos, anesthesiologist soanil Hospital Santa Cruz - São Paulo S. P. Brazil
Send letter to journal:
|
Dear sir I intubate my obese patients in semi-sitting position, 45 degree of elevation of the shoulders and head and neck. This is to facilitate the tracheal intubation, that is often difficult in the very obese; In addition, I believe that it improves the time taken for desaturation after onset of apnoea. Did you intubate the patients of the 'sitting group' in the sitting position? Or did you pre-oxygenated them in siting position and then placed them supine to intubate? Marcelo S. Ramos Conflict of Interest:None declared |
|||
|
|
|||
|
Sunil Kannanparambil, Senior House Officer Department of Anaesthetics,Mayday Hospital,Croydon,UK.
Send letter to journal:
|
Dear Sir I read with interest the article on the effect of body posture during pre-oxygenation and tolerance of apnoea. I strongly agree with you about the advantages of sitting up patients with high body mass index(BMI) during pre-oxygenation since it has unquestionable advantage of improving the functional residual capacity(FRC). The ventilation perfusion mismatch following induction of anaesthesia can have an effect on the tolerance of apnoea and time taken for desaturation.This can be explained on the effect of closing capacity encroaching upon the FRC.So intubation in semi-supine has an added advantage. I am not sure about the method of induction used in these patients and what drugs were used. Were the intubation in both groups done in the supine position? And during the period of apnoea did they receive any supplimental oxygen? Sincerely Dr Sunil Kannanparambil SHO - Anaesthetics Mayday Hospital Croydon United Kingdom CR7 7YE Conflict of Interest:None declared |
|||