In order to start the Article of the Month process, I have selected two articles, both related to the importance of pre-oxygenation. One of the articles discusses the physiological basis, benefits and potential risks of pre-oxygenation:

Anesth Analg. 2017 Feb;124(2):507-517. doi: 10.1213/ANE.0000000000001589. Preoxygenation: Physiologic Basis, Benefits, and Potential Risks. Nimmagadda U, Salem MR, Crystal GJ.

I have also included two meta-analyses from the emergency medicine journals related to the pre-oxyganation in the emergency room. What works in the emergency room is likely to be relevant under more controlled conditions in the operating room:

Am J Emerg Med. 2017 Aug;35(8):1184-1189. doi: 10.1016/j.ajem.2017.06.029. Epub 2017 Jun 15. Apneic oxygenation reduces the incidence of hypoxemia during emergency intubation: A systematic review and meta-analysis. Pavlov I, Medrano S, Weingart S.

Am J Emerg Med. 2017 Oct;35(10):1542-1546. doi: 10.1016/j.ajem.2017.06.046. Epub 2017 Jun 24. Apneic oxygenation during intubation in the emergency department and during retrieval: A systematic review and meta-analysis. Binks MJ, Holyoak RS, Melhuish TM, Vlok R, Bond E, White LD.

With that you should have enough arguments for any discussion about this topic.

Have fun in reading the articles that will be provided to EAMS members with login to eamshq.net as full-text PDF's.

Best regards
Tino Greif
President of the European Airway Management Society

Dear Colleagues;

This month, the articles are related with tracheal extubation. The first paper is a guideline on ‘’Intubation and extubation of the ICU patient’’. You will find recommendations from experts of the SFAR and SRLF.

Quintard H, l'Her E, Pottecher J, Adnet F, Constantin JM, De Jong A, Diemunsch P, Fesseau R, Freynet A, Girault C, Guitton C, Hamonic Y, Maury E, Mekontso-Dessap A, Michel F, Nolent P, Perbet S, Prat G, Roquilly A, Tazarourte K, Terzi N, Thille AW, Alves M, Gayat E, Donetti L. Intubation and extubation of the ICU patient. Anaesth Crit Care Pain Med 2017 Oct;36(5):327-341.

No abstract available

The second paper is again from France: a randomised controlled trial  which compares suction with positive pressure before extubation in adult patients.

L'Hermite J, Wira O, Castelli C, de La Coussaye JE, Ripart J, Cuvillon P. Tracheal extubation with suction vs. positive pressure during emergence from general anaesthesia in adults: A randomised controlled trial. Anaesth Crit Care Pain Med 2017 Sep 4. pii: S2352-5568(17)30001-2. doi: 10.1016/j.accpm.2017.07.005. 

Abstract:
After general anaesthesia (GA) in adults, the optimal tracheal extubation technique (positiveBackground: After general anaesthesia (GA) in adults, the optimal tracheal extubation technique (positivepressure or suctioning) remains debated. The primary endpoint of this study was to assess the effects ofthese techniques on onset time of desaturation (SpO2 < 92%).Methods: Sixty-nine patients with a body mass index < 30 scheduled for elective orthopaedic surgerywere allocated to positive pressure (PP) or suctioning (SUC) group. GA was standardised with propofoland remifentanil via target-controlled infusion. A morphine bolus of 0.15 mg/kg was administered 20–30 mins before the end of surgery. The effect of extubation technique on onset time of desaturation (T92)was assessed during the first 10 mins after extubation during the spontaneous air breathing. Secondaryendpoints included: frequency of desaturation, respiratory complications, need to use oxygen therapyand SpO2 at the end of the first hour while breathing in air (ClinicalTrials.gov identifier: NCT01323049).Results: Baseline patient characteristics and intraoperative management data for the 68 patientsincluded had no relevant clinical difference between groups. T92 (sec) after tracheal extubation was 214(168) vs. 248 (148) in the PP and SUC groups, respectively (P = 0.44). In the PP and SUC groups, 50 and43% reached a SpO2 < 92% within the first 10 mins after extubation respectively (P = 0.73). There were nostatistically significant differences between groups for any secondary endpoints.Conclusions: Positive pressure extubation as compared with suctioning extubation did not seem to delayonset time of desaturation after GA in standard weight adult patients.

Please be aware that the full texts will be provided to EAMS members with login to eamshq.net.

With best wishes
Kemal Tolga Saracoglu
Co-secretary of the European Airway Management Society

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