Evaluation of the relationship between the stop-bang score with oxygen reserve index and difficult airway: a prospective observational study
Avaliação da relação entre o escore stop-bang com o índice de reserva de oxigênio e via aérea difícil: um estudo observacional prospectivo
Ilka D. Alp, Bengü G. Köksal, Keziban Bollucuoğlu, Gamze Küçükosman, Özcan Pişkin, Çağdaş Baytar, Rahşan D. Okyay, Hilal Ayoğlu
Abstract
Background
Patients diagnosed with Obstructive Sleep Apnea (OSA) syndrome have a tendency towards hypoventilation, hypoxia, and hypercarbia in the perioperative period. This study hypothesized that the Oxygen Reserve Index (ORi) could predict possible hypoxia and determine difficult airways in patients at risk for OSA, as determined by the STOP-Bang questionnaire.
Methods
This prospective study included adult patients undergoing elective surgery under general anesthesia with endotracheal intubation, divided into two groups: low risk (0–2 points) and high risk (3–8 points) based on their STOP-Bang questionnaire results. The primary outcome measure was the highest ORi value reached during preoxygenation and the time to reach this value. Data were recorded at four time points: before preoxygenation (T1), end of preoxygenation (T2), end of mask ventilation (T3), and end of intubation (T4), as well as partial oxygen pressure values in T1, T2, and T4. The secondary outcome measures were the grading scale for mask ventilation, Cormack-Lehane score, tonsil dimensions, use of a stylet, and application of the burp maneuver during intubation.
Results
In the high-risk group, preoperative peripheral oxygen saturation values, the highest ORi value reached in preoxygenation, and ORi values at T3 and T4 times were lower, and the time to reach the highest ORi value was longer (p < 0.05).
Conclusion
Using ORi in patients with OSA may be useful in evaluating oxygenation, and since difficult airway is more common, ORi monitoring will better manage possible hypoxic conditions.
Keywords
Resumo
Introdução
Pacientes com diagnóstico de síndrome da apneia obstrutiva do sono (AOS) apresentam tendência à hipoventilação, hipóxia e hipercapnia no período perioperatório. Este estudo levantou a hipótese de que o Índice de Reserva de Oxigênio (ORi) poderia prever possível hipóxia e determinar vias aéreas difíceis em pacientes com risco de AOS, conforme determinado pelo questionário STOP-Bang.
Métodos
Este estudo prospectivo incluiu pacientes adultos submetidos a cirurgia eletiva sob anestesia geral com intubação endotraqueal, divididos em dois grupos: baixo risco (0–2 pontos) e alto risco (3–8 pontos) com base nos resultados do questionário STOP-Bang. O desfecho primário foi o maior valor de ORi alcançado durante a pré-oxigenação e o tempo para atingir esse valor. Os dados foram registrados em quatro momentos: antes da pré-oxigenação (T1), final da pré-oxigenação (T2), final da ventilação com máscara (T3) e final da intubação (T4), bem como valores de pressão parcial de oxigênio em T1, T2 e T4. Os desfechos secundários foram a escala de classificação para ventilação com máscara, escore de Cormack-Lehane, dimensões das amígdalas, uso de estilete e aplicação da manobra de arroto durante a intubação.
Resultados
No grupo de alto risco, os valores de saturação periférica de oxigênio pré-operatória, o maior valor de ORi alcançado na pré-oxigenação e os valores de ORi nos tempos T3 e T4 foram menores, e o tempo para atingir o maior valor de ORi foi maior (p < 0,05).
Conclusão
O uso do ORi em pacientes com AOS pode ser útil na avaliação da oxigenação e, como a via aérea difícil é mais comum, o monitoramento do ORi irá gerenciar melhor possíveis condições de hipóxia.
Palavras-chave
References
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Submitted date:
03/15/2023
Accepted date:
07/21/2023
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