Emergency Medicine Forum

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1.  According to a study of anesthesia patients, after pre-oxygenation, oxygen de-saturation occurred in 11% of patients after 1 mg/kg of succinylcholine (during rapid sequence intubation) before the resumption of effective spontaneous ventilation.  Their conclusion was that the use of succinylcholine may not always prevent de-saturation in event of failure to intubate or ventilate in the pre-oxygenated patient.  This patient may de-saturate even faster as they have increased oxygen consumption (septic state). 

Hays AH, Breslin DS, Mirakhur RK, Reid JE, O’Hare RA.  Frequency of haemoglobin desaturation with the use of succinylcholine during rapid sewquence induction of anaesthesia. Acta Anaesthesiol Scand. 2001 Jul;45(6):746-9.

2.  In one study, despite the same duration of preoxygenation, younger children were more susceptible than older ones to the risk of hypoxemia during apnea (it happened faster, and had a longer recovery time after manual ventilation initiation).  There was a linear  correlation of apnea time to 95% saturation with age, body weight, and height. 

Xue FS, Luo LK, Tong SY, Liao X, Deng XM, an G.  Study of the safe threshold of apneic period in children during anesthesia induction. J Clin Anesth 1996 Nov;8(7):568-74.

3. In one study, having the patient take 8 deep breaths over 60 seconds was actually found to be superior to the 5 min breathing 100% oxygen technique.  It allowed 4.7 minutes until de-oxygenation (in normal ASA I-II adults having elective surgery) compared to 3.7 min in the traditional method.  While this cannot be translated exactly to our patient population who frequently have substantial other issues (shock, sepsis, hypoxemia on 100% oxygen, etc.) it may improve the oxygenation prior to intubation by getting the patient to take several deep breaths of 100% oxygen.  Read this free online article for more information.

Balwinderjit S, Afzal L, Kaur B, Osahan N.  Comparison of Pre-oxygenation by maximal breathing and tidal volume breathing techniques.  Indian J Anaest 2006;50(3):209-213

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