Apneic Oxygenation With a Nasal Cannula in the Obese and Morbidly Obese Surgical Patient

NCT ID: NCT03671837

Last Updated: 2020-03-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

135 participants

Study Classification

INTERVENTIONAL

Study Start Date

2017-07-12

Study Completion Date

2019-12-31

Brief Summary

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This prospective, randomized, double-blind study is intended to enroll a total of 100 patients with a BMI ≥ 40 kg/m2 and another 100 patients with a BMI ≥ 30 kg/m2 (but less than 40 kg/m2) undergoing surgery with general endotracheal anesthesia at Parkland Hospital. Patients will be randomized to receive either 15 L/min O2 or 15 L/min air from a standard nasal cannula during a simulated prolonged laryngoscopy. The anesthesia provider will do a direct laryngoscopy to ensure that the patient has a Cormack-Lehane grade I-II airway. Patients who have grade III-IV airways will be excluded from further study procedures and not analyzed. The rest of the anesthetic will not deviate from the standard of care. Anesthesia providers will be blinded as to whether patients are receiving oxygen or air during the apneic period.

Detailed Description

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Conditions

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Apneic; Oxygenation

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Oyxgen

Nasal Insufflation with 15 L/min O2 and a nasopharyngeal airway

Group Type EXPERIMENTAL

Oxygen

Intervention Type OTHER

15 L/min O2

Air

Nasal Insufflation with 15 L/min air and a nasopharyngeal airway

Group Type ACTIVE_COMPARATOR

Air

Intervention Type OTHER

15 L/min air

Interventions

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Oxygen

15 L/min O2

Intervention Type OTHER

Air

15 L/min air

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* 18-80 years old
* Obesity (BMI ≥ 30 kg/m2 ≤ 40 kg/m2)
* Morbid obesity (BMI ≥ 40 kg/m2)
* Scheduled for a non-emergent operation that requires general endotracheal anesthesia
* Willing and able to consent in English or Spanish
* No current history of advanced pulmonary or cardiovascular disease

Exclusion Criteria

* Age less than 18 or older than 70
* BMI \< 30 kg/m2
* Patient does not speak English or Spanish
* Family or personal history of malignant hyperthermia
* Patient refusal
* Monitored anesthesia care (MAC) or regional anesthesia planned
* Pregnant or nursing women
* "Stat" (emergent) cases
* Moderate to severe pulmonary disease (e.g., asthma, COPD, pulmonary fibrosis, pulmonary hypertension)
* Respiratory infection within the past 14 days (e.g., pneumonia, bronchitis)
* SpO2 \< 97% on room air
* Moderate to severe cardiac disease (e.g., CHF, CAD, aortic stenosis)
* Severe gastroesophageal reflux disease (GERD)
* Nasal obstruction (e.g., tumor)
* Elevated intracranial pressure (e.g., brain tumor)
* History of difficult airway
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Texas Southwestern Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Tiffany B Moon

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Tiffany Moon, MD

Role: PRINCIPAL_INVESTIGATOR

University of Texas Southwestern Medical Center

Locations

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Parkland Health & Hospital System

Dallas, Texas, United States

Site Status

Countries

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United States

References

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Jense HG, Dubin SA, Silverstein PI, O'Leary-Escolas U. Effect of obesity on safe duration of apnea in anesthetized humans. Anesth Analg. 1991 Jan;72(1):89-93. doi: 10.1213/00000539-199101000-00016.

Reference Type BACKGROUND
PMID: 1984382 (View on PubMed)

Huang KC, Kormas N, Steinbeck K, Loughnan G, Caterson ID. Resting metabolic rate in severely obese diabetic and nondiabetic subjects. Obes Res. 2004 May;12(5):840-5. doi: 10.1038/oby.2004.101.

Reference Type BACKGROUND
PMID: 15166305 (View on PubMed)

McCahon RA, Hardman JG. Fighting for breath: apnoea vs the anaesthetist. Anaesthesia. 2007 Feb;62(2):105-8. doi: 10.1111/j.1365-2044.2007.04932.x. No abstract available.

Reference Type BACKGROUND
PMID: 17223799 (View on PubMed)

Baraka AS, Taha SK, Siddik-Sayyid SM, Kanazi GE, El-Khatib MF, Dagher CM, Chehade JM, Abdallah FW, Hajj RE. Supplementation of pre-oxygenation in morbidly obese patients using nasopharyngeal oxygen insufflation. Anaesthesia. 2007 Aug;62(8):769-73. doi: 10.1111/j.1365-2044.2007.05104.x.

Reference Type BACKGROUND
PMID: 17635423 (View on PubMed)

Baraka AS, Taha SK, Aouad MT, El-Khatib MF, Kawkabani NI. Preoxygenation: comparison of maximal breathing and tidal volume breathing techniques. Anesthesiology. 1999 Sep;91(3):612-6. doi: 10.1097/00000542-199909000-00009.

Reference Type BACKGROUND
PMID: 10485768 (View on PubMed)

Ramachandran SK, Cosnowski A, Shanks A, Turner CR. Apneic oxygenation during prolonged laryngoscopy in obese patients: a randomized, controlled trial of nasal oxygen administration. J Clin Anesth. 2010 May;22(3):164-8. doi: 10.1016/j.jclinane.2009.05.006.

Reference Type BACKGROUND
PMID: 20400000 (View on PubMed)

Lopez PP, Stefan B, Schulman CI, Byers PM. Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery. Am Surg. 2008 Sep;74(9):834-8.

Reference Type BACKGROUND
PMID: 18807673 (View on PubMed)

Heier T, Feiner JR, Lin J, Brown R, Caldwell JE. Hemoglobin desaturation after succinylcholine-induced apnea: a study of the recovery of spontaneous ventilation in healthy volunteers. Anesthesiology. 2001 May;94(5):754-9. doi: 10.1097/00000542-200105000-00011.

Reference Type BACKGROUND
PMID: 11388524 (View on PubMed)

Campbell IT, Beatty PC. Monitoring preoxygenation. Br J Anaesth. 1994 Jan;72(1):3-4. doi: 10.1093/bja/72.1.3. No abstract available.

Reference Type BACKGROUND
PMID: 8110546 (View on PubMed)

FRUMIN MJ, EPSTEIN RM, COHEN G. Apneic oxygenation in man. Anesthesiology. 1959 Nov-Dec;20:789-98. doi: 10.1097/00000542-195911000-00007. No abstract available.

Reference Type BACKGROUND
PMID: 13825447 (View on PubMed)

Dixon BJ, Dixon JB, Carden JR, Burn AJ, Schachter LM, Playfair JM, Laurie CP, O'Brien PE. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Anesthesiology. 2005 Jun;102(6):1110-5; discussion 5A. doi: 10.1097/00000542-200506000-00009.

Reference Type BACKGROUND
PMID: 15915022 (View on PubMed)

Damia G, Mascheroni D, Croci M, Tarenzi L. Perioperative changes in functional residual capacity in morbidly obese patients. Br J Anaesth. 1988 Apr;60(5):574-8. doi: 10.1093/bja/60.5.574.

Reference Type BACKGROUND
PMID: 3377932 (View on PubMed)

Don HF, Wahba M, Cuadrado L, Kelkar K. The effects of anesthesia and 100 per cent oxygen on the functional residual capacity of the lungs. Anesthesiology. 1970 Jun;32(6):521-9. doi: 10.1097/00000542-197006000-00012. No abstract available.

Reference Type BACKGROUND
PMID: 5426264 (View on PubMed)

Taha SK, Siddik-Sayyid SM, El-Khatib MF, Dagher CM, Hakki MA, Baraka AS. Nasopharyngeal oxygen insufflation following pre-oxygenation using the four deep breath technique. Anaesthesia. 2006 May;61(5):427-30. doi: 10.1111/j.1365-2044.2006.04610.x.

Reference Type BACKGROUND
PMID: 16674614 (View on PubMed)

Dyett JF, Moser MS, Tobin AE. Prospective observational study of emergency airway management in the critical care environment of a tertiary hospital in Melbourne. Anaesth Intensive Care. 2015 Sep;43(5):577-86. doi: 10.1177/0310057X1504300505.

Reference Type BACKGROUND
PMID: 26310407 (View on PubMed)

Sakles JC, Mosier JM, Patanwala AE, Dicken JM. Apneic oxygenation is associated with a reduction in the incidence of hypoxemia during the RSI of patients with intracranial hemorrhage in the emergency department. Intern Emerg Med. 2016 Oct;11(7):983-92. doi: 10.1007/s11739-016-1396-8. Epub 2016 Feb 4.

Reference Type BACKGROUND
PMID: 26846234 (View on PubMed)

Other Identifiers

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STU 022017-074

Identifier Type: -

Identifier Source: org_study_id

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