Head Elevation During Pre-oxygenation Can Delay Desaturation Time

Study Overview
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Brief Summary
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This study is a randomized-controlled trial study comparing the association between several degree of head elevation and conventional position during pre-oxygenation to desaturation time in patients undergo endotracheal intubation with general anesthesia

Detailed Description
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Preoxygenation anesthesia induction is an important part of airway management to reduce the risk of hypoxemia when the patient is apneic. The effectivity of preoxygenation is influenced by several things such as patient's head position. This study aimed to compare preoxygenation with head elevation 20°, 30° and 45° and conventional position to the time of desaturation before endotracheal intubation in patients undergoing general anesthesia. This was a randomized clinical trial of 56 patients, divided into four groups (conventional or 0° head elevation group, 20° head elevation group, 30° head elevation and 45° head elevation group). All subject was preoxygenated for 3 minutes with 100% oxygen. Induction of anesthesia was started with fentanyl, propofol, followed by rocuronium after the patient lost consciousness. Time was recorded from the start of induction until the oxygen saturation showed 93% or a time limit of 5 minutes. There was a significant difference in mean desaturation time among the four groups (p = 0.011). The most significant different was in 45o head elevation group (p < 0.05). . In patients undergoing general anesthesia, pre-oxygenation with head elevation 20°, 30° and 45° slows down the time for desaturation before endotracheal intubation compared to the conventional position. The 45° head elevation has the best result.

Official Title
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Head Elevation During Pre-oxygenation Can Delay Desaturation Time in Indonesian Patients

Conditions
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Surgery, Desaturation of Blood, Apnea

Intervention / Treatment
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* Procedure: Supine position
* Procedure: 20 degree head elevation position
* Procedure: 30 degree head elevation position
* Procedure: 45 degree head elevation position


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: undergo endotracheal intubation with general anesthesia for elective surgery aged 18-60 years old ASA physical status 1-2 preoperatively Exclusion Criteria: Patients with difficult airway, cardiopulmonary disease, anemia, grade II obesity, pregnant, history of hypersensitivity to induction agents Patients did not give consent to follow the study

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Patients were divided into 4 groups by random sampling each with different intervention
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Control<br>Patient positioned in supine conventional position | Procedure: Supine position<br>* Patients preoxygenated in supine position before endotracheal intubation<br>|
| Active Comparator: 20 degree head elevation<br>Patient positioned in 20 degree head elevation position | Procedure: 20 degree head elevation position<br>* Patients preoxygenated in 20 degree head elevation position before endotracheal intubation<br>|
| Active Comparator: 30 degree head elevation<br>Patient positioned in 30 degree head elevation position | Procedure: 30 degree head elevation position<br>* Patients preoxygenated in 30 degree head elevation position before endotracheal intubation<br>|
| Active Comparator: 45 degree head elevation<br>Patient positioned in 45 degree head elevation position | Procedure: 45 degree head elevation position<br>* Patients preoxygenated in 45 degree head elevation position before endotracheal intubation<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Desaturation time | Time was recorded from the start of induction until the oxygen saturation showed 93% or a time limit of 5 minutes | Right after induction until reach oxygen saturation 93% or 5 minutes time limit | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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preoxygenation, head elevation, desaturation, apnea