• Xiaotian Zhou, Xinyi Huang, Zijun Zhou, Qingqing Xu, Aishuang Mei, Lelethu Xakatha Mazomba, and Jiehao Sun.
• From the Department of Anaesthesiology (XZ, XH, ZZ, LXM, JS), Operating Room Nursing Department (QX) and Post Anaesthesia Care Unit Nursing (AM), 1st affiliated hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
• Eur J Anaesthesiol. 2023 Jul 1; 40 (7): 521528521-528.

BackgroundMask ventilation during anaesthesia induction is generally used to provide adequate oxygenation but improper mask ventilation can result in gastric insufflation. It has been reported that oxygen administered by transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) during anaesthesia induction can maintain oxygenation but its effect on gastric insufflation is unknown.ObjectivesThe primary aim of this study was to evaluate whether THRIVE provided adequate oxygenation without gastric insufflation. The secondary aim was to explore the change in cross-sectional area of the antrum (CSAa) during anaesthesia induction. Other potential risk factors of gastric insufflation were also explored.DesignA prospective, randomised, double-blind study.SettingSingle centre, Department of Anaesthesiology, 1 st Affiliated Hospital, Wenzhou Medical University, China, from May 2022 to September 2022.PatientsA total of 210 patients (age >18 years, ASA classification I to III) scheduled to undergo general anaesthesia were enrolled.InterventionsFor induction of general anaesthesia, patients were randomised into two groups: THRIVE and pressure-controlled facemask ventilation (PCFV). The THRIVE group received high-flow nasal oxygen with no additional ventilation. The PCFV group had pressure-controlled positive pressure ventilation from the anaesthesia machine via a tight fitting facemask. Gastric insufflation was detected using real-time ultrasonography. The CSAa was measured from ultrasonography images obtained before anaesthesia induction and at 0, 1, 2 and 3 min after loss of consciousness.Main Outcome MeasuresThe incidence of gastric insufflation during the period from loss of consciousness until intubation.ResultsThe THRIVE group had a lower incidence of gastric insufflation during anaesthesia induction than the PCFV group (13.0 vs. 35.3%, odds ratio (OR) = 0.27, 95% confidence interval (CI), 0.14 to 0.56, P  < 0.001). Increase in the CSA after anaesthesia induction was significantly correlated with gastric insufflation (OR = 5.35, 95% CI, 2.90 to 9.89, P  < 0.001). Multivariate logistic regression analysis showed that advancing age (OR = 1.04, 95% CI, 1.01 to 1.07), obstructive sleep apnoea syndrome (OR = 2.43, 95% CI, 1.24 to 4.76), higher Mallampati score (OR = 2.66, 95% CI, 1.21 to 5.85) and PCFV (OR = 4.78, 95% CI, 2.06 to 11.06) were important independent risk factors for gastric insufflation.ConclusionDuring anaesthesia induction, the THRIVE technique provided adequate oxygenation with a reduced incidence of gastric insufflation. PCFV, advancing age, obstructive sleep apnoea syndrome and the Mallampati score were found to be independent risk factors for gastric insufflation during anaesthesia induction.Trial RegistrationChinese Clinical Trial Registry ChiCTR200059555.Copyright © 2023 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

23 keywords...

hide…