Short-Term Outcomes of Low Versus High Inspiratory Oxygen Fraction during Induction of General Anesthesia in Noncardiac Surgery: A Pragmatic Open-Label Randomized Non-Inferiority Trial

Tzu-Huan Su ； Kuang-Yao Li ； Tzu-Shan Chen ； Shu-Ching Chang ； Yi-Kai Su ； Chung-Yi Li ； Chen-Fuh Lam

《E-Da Medical Journal》 10卷1期 (2023/03) Pp. 32-43

https://doi.org/10.6966/EDMJ.202303_10(1).0004

摘要

Objective: High inspiratory oxygen fraction (FiO_2) is associated with increased perioperative pulmonary morbidity and postoperative mortality. However, the use of 100% oxygen is still currently recommended during the anesthesia induction. Methods: This open-label randomized non-inferiority trial was conducted in 302 surgical patients [American Society of Anesthesiologists (ASA) physical classifications ≤ III] who received endotracheal tube intubation general anesthesia (ETGA), and they were randomized to receive 100% (FiO_2 1.0) or 60% (FiO_2 0.6) oxygen during induction. The primary endpoint was presence of hypoxemia (SpO_2 ≤ 92% during the induction of anesthesia. The secondary endpoint was the development of major complications immediately and within 3 days after surgery. Results: A total of 5 patients in the FiO_2 0.6 group developed hypoxemia during induction (3.9% vs. 0% for FiO_2 0.6 vs. FiO_2 1.0, respectively; p = 0.167 for non-inferiority), suggesting that FiO_2 0.6 was inferior than FiO_2 1.0 for anesthesia induction. The mean lowest SpO_2 during induction was also significantly lower in FiO_2 0.6 group. Four patients with increased body mass indexes (BMI > 30 kg/m^2) reached the primary endpoint. However, the overall incidence of desaturation developed after removal of endotracheal tube was higher in FiO_2 1.0 group (1.4% vs. 5.8%, FiO_2 0.6 vs. FiO_2 1.0; odd ratio O.22, 95% confidence interval 0.05-1.05; p = 0.064). Conclusion: High fractions of oxygen should be used for oxygenation during induction of ETGA in general population, especially in the obese patients. However, the supplement of high FiO_2 during induction was associated with increased hypoxemic events after removal of endotracheal tube that might have a more significant impact on perioperative care.

關鍵字

acute respiratory distress ； general anesthesia ； induction ； oxygen

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