End-tidal oxygen concentration and pulse oximetry for monitoring oxygenation during intratracheal jet ventilation |
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| Authors: | Dr Gerhard A. Baer MD Markku Paloheimo MD Jorma Rahnasto MD Juhani Pukander MD |
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| Affiliation: | (1) From the Department of Anaesthesiology, ORL-Clinic, Tampere University Hospital, Tampere, Finland;(2) From the ORL-Clinic, Tampere University Hospital, Tampere, Finland;(3) the Department of Clinical Medicine, Tampere University, Tampere, Finland;(4) the Anaesthesiology Clinic, Eye Hospital, Helsinki University, Helsinki, Finland |
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| Abstract: | Objective. In this study, we evaluated the usefulness of end-tidal oxygen monitoring during intratracheal jet ventilation (ITJV) for endolaryngeal laser surgery.Methods. A total of 20 consecutive patients of both genders scheduled for endolaryngeal procedures under general anesthesia were studied. Inspiratory oxygen concentration and respiratory rate were varied, with patients serving as their own controls. Readings of pulse oximetry, airway oxygen, and carbon dioxide concentrations were recorded, and arterial blood samples for blood gas analysis were taken.Results. At jet cycle rates of 20 cycles/min, end-tidal oxygen (ETo2) concentration indicated alveolar hypoxia 30 to 60 sec before hypoxemia was detected by pulse oximetry. Jet mixing of inspiratory and expiratory gas caused a larger difference between end-tidal and arterial gas concentrations than normally seen with conventional ventilation. Correlations between ETo2 concentrations, oxygen saturations, and arterial oxygen levels depended on respiratory rate and inspiratory oxygen concentration; correlations were stronger at low than at high inspiratory oxygen concentrations and stronger at low than at high respiratory rates.Conclusions. ETo2 concentration should be maintained well over 21% during ITJV to prevent alveolar and arterial hypoxia. Monitoring of respiratory oxygen concentrations at jet cycle rates of 20 cycles/min and less verifies safe oxygen levels during laser surgery, and confirms adequate alveolar oxygenation.We are grateful to Anneli Innanmaa, RN, for her skillful help with this study, and to Hannu Laine, fine mechanic, for the construction of the copper tubes.Grants were received from Instrumentarium Scientific Foundation, Helsinki, for construction of the special jet ventilator and the pressure curve monitor. Datex, Helsinki, provided the OSCAR OXY monitor.Part of the results of this study were presented at the 10th World Congress of Anaesthesiologists, The Hague, 1992 (Abstract A41 [ISBN 90-800899-2-3]). |
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| Keywords: | Ventilation: intratracheal jet Monitoring: endtidal oxygen? oxygenation Measurement technique: pulse oximetry Procedures: endolaryngeal laser surgery Complications: fire hazard |
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