2022年 · 第102卷第21期

A total of 565 patients undergoing gastroscopy under intravenous anesthesia were selected for the study and randomly assigned to receive nasal mask oxygen (n=283) and the conventional nasal tube oxygen administration group (n=282）。 The primary outcome measure was the incidence of hypoxemia, and secondary outcome measures included the incidence of severe hypoxemia, duration of hypoxemia, minimum oxygen saturation, proportion requiring emergency airway treatment, time to surgery, time to recovery, satisfaction of anesthesiologists and gastrointestinal endoscopists, and other adverse events (including cough, hiccups, nausea and vomiting, reflux, aspiration, and laryngospasm).

A multicenter, open-label, rater-blinded randomized controlled trial compared high-flow nasal tube oxygen therapy (HFNO) at 70 L/min and 50% oxygen concentration with conventional oxygen therapy (6 L/min with nasal tube or mask, or 5 L/min with nasopharyngeal airway) on the incidence of hypoxia in digestive endoscopic deep sedation in moderate and high-risk patients. From March to September 2019, a total of 380 patients with combined sleep apnea, obesity, hypertension, diabetes, heart disease, age>60 years, or American Society of Anesthesiologists (ASA)>Class I digestive endoscopy were enrolled in the study. Patients were randomly assigned to the HFNO group (n=191) and standard oxygen therapy group (n=188）。 The primary outcome measure was oxygen saturation (SpO₂) ≤92% incidence. HFNO Group SpO₂The incidence of ≤92% was 9.4% (18/191), significantly lower than 33.5% (63/188) in the standard oxygen therapy group. Lowest SpO between groups₂The median of the difference was 2%. In the HFNO group compared with the standard oxygen therapy group, SpO₂≤90% [5.8% (11/191) vs 22.9% (43/188)], SpO₂The incidence of events ≤85% [3.1% (6/191) vs. 9.6% (18/188)], requiring manual airway opening [11.1% (21/191) vs. 32.4% (61/188)], and requiring increased oxygen flow [7.9% (15/191) vs. 23.4% (44/188)] was significantly lower than in the standard oxygen therapy group. It is suggested that HFNO can reduce the risk of hypoxia in patients with intermediate and high risk during digestive endoscopic deep sedation.

In recent years, the efficacy of high-flow nasal catheter oxygen therapy (HFNO) for oxygenation maintenance in normal populations has been widely recognized, but its use in obese populations has not been fully validated. A recent randomized controlled trial compared the effects of 70 L/min HFNO versus 15 L/min closed mask (FM) administration of 100% oxygen on asphyxia time after general anesthesia and neuromuscular block in morbidly obese patients. A total of 80 patients aged 18 to 65 years with a body mass index (BMI)>40 kg/m were enrolled in the study between October 2018 and September 2019²of patients undergoing bariatric surgery, randomly assigned to the HFNO group (n=41) and the FM group (n=39）。 Anesthesia was induced after pre-oxygenation in 45° half-sitting position, and rocuronium was given to start asphyxia and oxygenation. The oropharyngeal airway and mandibular lifting manipulation were used to maintain the patency of the upper airway, and the observation was performed for 18 minutes. The primary study endpoint was the time to asphyxia when oxygen saturation decreased to 92%. Asphyxia time in the HFNO and FM groups [M（Q₁，Q₃)] 18 (18, 18), 18 (4, 18) min, respectively. Oxygen saturation decreased to 92% within 18 min in 5 (12%) patients in the HFNO group and 15 (38%) patients in the FM group.

A deep neuromuscular block may be beneficial for surgical space conditions during laparoscopic surgery. However, intraoperative deep neuromuscular block inevitably increases the risk of residual muscle relaxants after surgery, prolonging the extubation time and stay in the anesthesia recovery room (PACU). The effect of moderate neuromuscular block combined with transversal ventral block (TAPB) on surgical space conditions during laparoscopic surgery has not been reported. The study explored whether the above combination is similar to the surgical spatial conditions of deep neuromuscular block while being more conducive to patient recovery.

Tracheectomy and reconstruction are the most effective treatments for tracheal stenosis. The difficulty is that surgeons and anesthesiologists need to operate and maintain ventilation in the same airway of the patient. It is a challenge for anesthesiologists to ensure patient ventilation safety and surgical field satisfaction. High-flow oxygen has begun to be used to prolong apnea time, and this study aimed to evaluate the effectiveness of apnea conditions with high-flow oxygen as the only means of gas exchange during tracheal anastomosis reconstruction.