Ahmet ARIKAN, Alparslan KUŞ, Sevim CESUR, Neşe TÜRKYILMAZ, Zafer TAŞ, Zeynep Mine SOLAK, Tülay HOŞTEN

Comparison of tidal volume and deep breath preoxygenation techniquesundergoing coronary artery bypass graft surgery: effects of hemodynamicresponse and arterial oxygenation

Background/aim: Different techniques exist for the preoxygenation of patients that will be operated on under general anesthesia. Preoxygenation with the deep breath (DB) method may affect cardiovascular stability, which is crucial for coronary artery bypass graft (CABG) patients. In this study, we aimed to compare the effects of the 3 min TVB preoxygenation technique and 1 min 8DBs technique on hemodynamic response and arterial oxygenation in patients with normal ejection fraction that were scheduled for elective CABG surgery. Materials and methods: Forty patients classified as ASA II III and scheduled for elective CABG surgery were randomly assigned to TVB/3 min or 8DBs/1 min for preoxygenation. Cardiovascular variables, i.e. heart rate, mean arterial pressure, central venous pressure, cardiac index, systemic vascular resistance index, and stroke volume index, and arterial blood gas samples were analyzed before and after preoxygenation and at the end of the apneic period before intubation. Results: The preoxygenation methods affected the hemodynamic response similarly. PaO2 increased significantly with 8DBs compared to the TVB at the end of preoxygenation but was similar between the groups at the end of the apneic period (respectively, P: 0.03; P: 0.15). PaCO2 changes were similar between the groups. Conclusion: In patients with normal ejection fraction scheduled for CABG, 8DBs can be an alternative to TVB preoxygenation. Our results should be compared with those of other studies.

PDF

___

1. Baraka AS, Taha SK, El-Khatib MF, Massouh FM, Jabbour DG, Alameddine MM. Oxygenation using tidal volume breathing after maximal exhalation. Anesth Analg 2003; 97: 1533-1535.
2. Hamilton WK, Eastwood DW. A study of denitrogenation with some inhalation anesthetic systems. Anesthesiology 1955; 16: 861-867.
3. Dillon J, Darsie M. Oxygen for acute respiratory depression due to administration of thiopental sodium. J Am Med Assoc 1955; 159: 1114-1116.
4. Baraka AS, Taha SK, Aouad MT, El-Khatib MF, Kawkabani NI. Preoxygenation: comparison of maximal breathing and tidal volume breathing techniques. Anesthesiology 1999; 91: 612-616.
5. Butterworth JF IV, Bean EV, Royster RL. Rapid sequence induction of anesthesia for coronary artery bypass surgery: etomidate versus sufentanil. (Abstract) Anesth Analg 1988; 67: 5.
6. Pandit JJ, Duncan T, Robbins PA. Total oxygen uptake with two maximal breathing techniques and the tidal volume breathing technique: a physiologic study of preoxygenation. Anesthesiology 2003; 99: 841-846.
7. Nimmagadda U, Chiravuri SD, Salem MR, Joseph NJ, Wafai Y, Crystal GJ, El-Orbany MI. Preoxygenation with tidal volume and deep breathing techniques: the impact of duration of breathing and fresh gas flow. Anesth Analg 2001; 92: 1337-1341.
8. Mori H, Yamamoto H, Kuwashima M, Saito S, Ukai H, Hirao K, Yamauchi M, Umemura S. How does deep breathing affect office blood pressure and pulse rate? Hypertens Res 2005; 28: 499-504.
9. Al-Shamma Yesar MH, Zwain Akeel AMH, Al-Muhanna Muntadhar YI. The effect of deep inspiration and forced expiration on doppler transmittal flow, cardiac output. Kufa Medical Journal 2009; 2: 306-324.
10. Bernardi L, Gabutti A, Porta C, Spicuzza L. Slow breathing reduces chemoreflex response to hypoxia and hypercapnia, and increases baroreflex sensitivity. J Hypertens 2001; 19: 2221-2229.
11. Bernardi L, Porta C, Spicuzza L, Bellwon J, Spadacini G, Frey AW, Yeung LY, Sanderson JE, Pedretti R, Tramarin R. Slow breathing increases arterial baroreflex sensitivity in patients with chronic heart failure. Circulation 2002; 105: 143-145.
12. Goso Y, Asanoi H, Ishise H, Kameyama T, Hirai T, Nozawa T, Takashima S, Umeno K, Inoue H. Respiratory modulation of muscle sympathetic nerve activity in patients with chronic heart failure. Circulation 2001; 104: 418-423.
13. Joseph CN, Porta C, Casucci G, Casiraghi N, Maffeis M, Rossi M, Bernardi L. Slow breathing improves arterial baroreflex sensitivity and decreases blood pressure in essential hypertension. Hypertension 2005; 46: 714-718.
14. Hayano J, Yasuma F, Okada A, Mukai S, Fujinami T (1996). Respiratory sinus arrhythmia. A phenomenon improving pulmonary gas exchange and circulatory efficiency. Circulation 1996; 15: 842-847.
15. Daly WJ, Bondurat S. Effects of oxygen breathing on the heart rate, blood pressure and cardiac index of normal menresting, with reactive hyperemia and after atropine. J Clin Invest 1962; 41: 126-132.
16. Gole Y, Gargne O, Coulange M, Steinberg JG, Bouhaddi M, Jammes Y, Regnard J, Boussuges A. Hyperoxia-induced alterations in cardiovascular function and autonomic control during return to normoxic breathing. Eur J Appl Physiol 2011; 111: 937-946.
17. Waring WS, Thomson AJ, Adwani SH, Rosseel AJ, Potter JF, Webb DJ, Maxwell SR. Cardiovascular effects of acute oxygen administration in healthy adults. J Cardiovasc Pharmacol 2003; 42: 245-50.
18. Bak Z, Sjoberg F, Rousseau A, Steinvall I, Janerot-Sjoberg B. Human cardiovascular dose-response to supplemental oxygen. Acta Physiol (Oxf) 2007; 191: 15-24.
19. Narkiewicz K, van de Borne PJ, Montano N, Dyken ME, Phillips BG, Somers VK. Contribution of tonic chemoreflex activation to sympathetic activity and blood pressure in patients with obstructive sleep apnea. Circulation 1998; 97: 943-945.
20. Siński M, Lewandowski J, Przybylski J, Bidiuk J, Abramczyk P, Ciarka A, Gaciong Z. Tonic activity of carotid body chemoreceptors contributes to the increased sympathetic drive in essential hypertension. Hypertens Res 2012; 35: 487-491.
21. Ciarka A, Najem B, Cuylits N, Leeman M, Xhaet O, Narkiewicz K, Antoine M, Degaute JP, van de Borne P. Effects of peripheral chemoreceptors deactivation on sympathetic activity in heart transplant recipients. Hypertension 2005; 45: 894-900.
22. Izdebska E, Cybulska I, Sawicki M, Izdebski J, Trzebski A. Postexercise decrease in arterial blood pressure, total peripheral resistance and in circulatory responses to brief hyperoxia in subjects with mild essential hypertension. J Hum Hypertens 1998; 12: 855-860.
23. Sinski M, Lewandowski J, Przybylski J, Zalewski P, Symonides B, Abramczyk P, Gaciong Z. Deactivation of carotid body chemoreceptors by hyperoxia decreases blood pressure in hypertensive patients. Hypertens Res 2014; 37: 858-862.
24. Mak S, Azevedo ER, Liu PP, Newton GE. Effect of hyperoxia on left ventricular function and filling pressures in patients with and without congestive heart failure. Chest 2001; 120: 467-473.
25. Haque WA, Boehmer J, Clemson BS, Leuenberger UA, Silber DH, Sinoway LI. Hemodynamic effects of supplemental oxygen administration in congestive heart failure. J Am Coll Cardiol 1997; 27: 353-357.
26. Nimmagadda U, Salem MR, Crystal GJ. Preoxygenation: physiologic basis, benefits, and potential risks. Anesth Analg 2017; 124: 507-517.
27. Singh B, Afzal L, Kaur B, Osahan NK. Comparison of preoxygenation by maxımal breathing and tidal volume breathing techniques. Indian J Anaesth 2006; 50: 209-213.
28. Pehlivanoğlu Ş, Bilgin H. Obez olguların preoksijenasyonunda CPAP, tidal volüm solunumu ve derin solunum tekniklerinin karşılaştırılması. Türk Anest Rean Der Dergisi 2004; 32: 449- 459.
29. Galyon SW. Preoxygenation of patients for coronary artery bypass grafting: vital capacity versus tidal breathing. AANA J 1990; 1: 45-48.
30. Preoxygenation: Science and practice (editorial). Lancet 1992; 339: 31-32.
31. Campbell IT, Beatty PC. Monitoring preoxygenation. Br J Anaesth 1994; 72: 3-4.
32. Gold M, Durate I, Muravchick S. Arterial oxygenation in conscious patients after 5 minutes and 30 seconds of oxygen breathing. Anesth Analg 1981; 60: 313-315.
33. Bourassa MG, Campeau L, Bois MA, Rico O. The effects of inhalation of 100 percent oxygen on myocardial lactate metabolism in coronary heart disease. Am J Cardiol 1969; 24: 172-177.
34. Farquhar H, Weatherall M, Wijesinghe M, Perrin K, Ranchord A, Simmonds M, Beasley R. Systematic review of studies of the effect of hyperoxia on coronary blood flow. Am Heart J 2009; 158: 371-377.
35. Freeman LJ, Nixon PG. Are coronary artery spasm and progressive damage to the heart associated with hyperventilation syndrome? Br Med J (Clin Res Ed) 1984; 291: 851-853.
36. Reinhart K, Specht M, Föhring U, Mayr O, Eyrich K. The effect of preoxygenation on hemodynamics and oxygen consumption. Anaesthesist 1989; 38: 233-237.
37. Practice guidelines for management of the difficult airway. A report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 1993; 78: 597-602.
38. Williamson JA, Webb RK, Szekely S, Gillies ER, Dreosti AV. The Australian Incident Monitoring Study. Difficult intubation: an analysis of 2000 incident reports. Anaesth Intensive Care 1993; 21: 602-607.
39. Young RW. Hyperoxia: a review of the risks and benefits in adult cardiac surgery. J Extra Corpor Technol 2012; 44: 241- 249.
40. Foadoddini M, Esmailidehaj M, Mehrani H, Sadraei SH, Golmanesh L, Wahhabaghai H, Valen G, Khoshbaten A. Pretreatment with hyperoxia reduces in vivo infarct size and cell death by apoptosis with an early and delayed phase of protection. Eur J Cardiothorac Surg 2011; 39: 233-240.