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October 16, 2011
8:00:00 AM - 11:00:00 AM
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Does No-Cost TSE "Mask" Improve Oxygenation and Reduces Severe Desaturation in Obese Patients during Cardioversion/AICD Testing?
Jana Janco, Vincent Cirella, M.D., Shaul Cohen, M.D., Gina George, D.O., James Tse, M.D.,Ph.D.
UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
Introduction: Patients routinely receive O2 via nasal cannula (NC) and IV propofol during cardioversion/AICD testing. Over-sedation and/or airway obstruction may cause severe desaturation (Desat). Obese patients have increased risk of respiratory complication during sedation due to a myriad of factors, such as airway anatomy, sleep apnea, decreased FRC and increased O2 consumption. A simple plastic sheet was shown to improve oxygenation in deeply sedated patients by transforming NC to a face tent (TSE "Mask") during upper GI endoscopy1. We wish to confirm its effectiveness in improving oxygenation in obese patients during cardioversion/AICD testing.

This retrospective review of 171 patients who underwent cardioversion/AICD testing identified 2 groups. Group1 (NC, n=48) received NC O2. Group 2 (TM, n=123) received NC O2 and a TSE "Mask" using a clean plastic specimen bag to cover the patient's nose and mouth (Photo).1-3 Monitors included ECG, BP cuff and pulse oximetry. Patients received NC O2 (3-5 l/min or higher as needed) and only IV propofol. Data collected included age, weight, height, O2 Sat, assisted bag-mask ventilation and the amount of propofol. Student t-test and the Chi Square test were used for statistical analysis. A p value <0.05 was considered as significant. (Mean±S.D.)

Results: Among non-obese patients (BMI <30), there were no differences in age (NC:72±13 yrs; TM:67±14), BMI (NC:24.3±3.5; TM:24.4±3.3), ASA Physical Status Classification (ASA) (all III), room air (RA) O2 Sat (NC:99±2%; TM:98±2%) and propofol dose (NC:1.47±2.2 mg/kg; TM:1.1±0.3). There were significant differences in NC O2 flow (NC:6.5±2.8 l/min; TM:4.6±1.3 ), O2 Sat after 5 min with O2 (NC:99±1%; TM:100±1%), the lowest O2 Sat (NC:87±11%; TM:97±3%) (Fig. 1), severe Desat (O2 Sat≤ 85%) (NC:10/29; TM:0/74) and assisted bag-mask ventilation (NC:8/29; TM:0/97) (Fig. 2).

Among obese patients (BMI>30), there were no differences in age (NC:66±11 yrs; TM:64±11), BMI (NC:34.7±4.7; ΤΜ:37.1±6.2), ASA ( all III), RA O2 Sat (98±2%) and propofol dose (NC:0.88±0.28 mg/kg; TM:0.77±0.31). There were significant differences in NC O2 flow (NC:8.1±2.4 l/min; TM:5.2±1.9), O2 Sat after 5 min with O2 (NC:98±2%; TM:99±1%), the lowest O2 Sat (NC:83±11%; TM:94±8%) (Fig.1), severe Desat (O2 Sat ≤ 85%) (NC:9/19; TM: 5/48) and assisted ventilation (NC:10/19; TM:2/48) (Fig. 2).

Discussion: These data show that TSE "Mask" improves oxygenation, prevents severe desaturation and reduces the need for assisted bag-mask ventilation in non-obese and obese patients during cardioversion/AICD testing. This face tent takes only a few seconds to prepare at no cost. It may have great impact on patient safety in obese patients and should be used routinely during cardioversion/AICD testing.

1.Anesth 107:A922, 2007; 2. Anesth 102:484, 2005;
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