Face Masks and Nasal Prongs for Postoperative Hypoxemia

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Early postoperative hypoxaemia is not uncommon when patients breath room air during their initial recovery period. Prolong hypoxaemia can result in delirium, arrhythmia, and cardiac arrest. We compared the efficacy of face masks and nasal prongs in the management of hypoxaemia following general anaesthesia relaxant technique. This was a prospective open labelled randomized controlled study which compared the performance of Face Mask and Nasal Prongs in the management of early postoperative hypoxia. All procedures were performed using standard anaesthetic and surgical techniques adapted to the individual procedures. At the end of surgery; all the patients were fully awake and had SPO ≥97% before transfer to the recovery room. On arrival in the recovery room, 120 subjects were randomly allocated into Face Mask group and Nasal Prong, when their SpO decreased to ≤ 94%, thereafter 4L/min of oxygen was administered through either devices. Early postoperative hypoxia occurred in 18.1%.

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A p value of <0.05 was considered significant for all tests. All analysis was performed using the Statistical Package for Social Sciences for Windows version 17 (SPSS, Chicago, IL). Hypoxaemia was graded into four values of SPO Mild (86-90%), Moderate (81-85%), Severe (76-80%), and Extreme (<80). The trigger value of oxygen saturation for commencement of oxygen therapy was SPO <94%. Tachycardia described as heart rate (HR) >100 beats/minute or 25% increase in heart rate from the baseline value. Bradycardia descried as HR< 60 beat/minutes or 25% decrease in heart rate. Hypertension described as SBP >140 mmHg, or 25% increase in SBP or DBP from the baseline. The level of consciousness (LOC/Sensorium) was graded into : 1-fully awake; 2 – Asleep but easily aroused; 3- Asleep and difficult to arouse. The Visual analogue scale was used to assess patient comfort in the use of the oxygen therapy devices: (VAS score, 100m = worst possible discomfort, 0mm = most comfortable).

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However, this is invasive technique, and the use is unethical in the present situation. Our result showed that the use of Nasal Prong was associated with better satisfaction for our patients than the Face Mask. This result is similar to the findings by other researchers. Nasal Prongs have also been shown to be cost effective, when compared with the face mask. This is very important in this period of global economic recession. This study is limited by the fact that the assessment of adequacy of oxygenation was determined with the pulse oximeter, we were unable to use the arterial blood analyser due to the cost implication. Likewise the clinical signs of carbon dioxide retention were used instead of a capnography as such was unavailable at the time of our study. Inspite of this we have demonstrated that he nasal prong was a more effective device of delivering oxygen in subjects with early postoperative hypoxia, it is also comfortable and cost effective.

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