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Anaesthesia. 2019 Apr;74(4):450-456. doi: 10.1111/anae.14567. Epub 2019 Jan 20.

High-flow nasal oxygen vs. standard flow-rate facemask pre-oxygenation in pregnant patients: a randomised physiological study.

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British Columbia Women's Hospital, Vancouver, BC, Canada.
University of British Columbia, Vancouver, BC, Canada.
Women's Health Research Institute, Vancouver, BC, Canada.


High-flow nasal oxygen has been shown to provide effective pre-oxygenation and prolong apnoeic time during intubation attempts in non-pregnant patients. We aimed to compare pre-oxygenation using high-flow nasal oxygen (30-70 l.min-1 oxygen flow) via nasal prongs with standard 15 l.min-1 oxygen breathing via a tight-fitting facemask. Forty healthy parturients were randomly allocated to these two groups, and furthermore each patient underwent the selected pre-oxygenation method with both 3-min tidal volume breathing and 30s tidal breathing followed by eight vital capacity breaths. With 3-min tidal volume breathing, the respective estimated marginal means for high-flow nasal oxygen and standard flow rate facemask pre-oxygenation were 87.4% (95%CI 85.5-89.2%) and 91.0% (95%CI 89.3-92.7%), p = 0.02; with eight vital capacity breaths the estimated marginal means were 85.9% (95%CI 84.1-87.7%) and 91.8% (95%CI 90.1-93.4%, p < 0.0001). Furthermore, high-flow nasal oxygen did not reliably achieve a mean end-tidal oxygen concentration ≥ 90% compared with the standard flow rate facemask. In this physiological study, high-flow nasal oxygen pre-oxygenation performed worse than standard flow rate facemask pre-oxygenation in healthy term parturients.


HFNO ; difficult airway: C-section; general anaesthesia: pregnancy; high-flow humidified nasal oxygen; obstetric anaesthesia; pre-oxygenation

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