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Oxygen in air (FIO₂ 0.4) improves gas exchange in young healthy patients during general anesthesia

[La présence d’oxygène dans de l’air (FiO₂ de 0,4) améliore les échanges gazeux chez de jeunes patients en bonne santé pendant l’anesthésie générale]

Anil Agarwal, MD^*, Prabhat K. Singh, MD^*, Sanjay Dhiraj, MD^*, Chandra M Pandey, PhD and Uttam Singh, PhD

^* From the Department of Anesthesia, and
Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.

Address correspondence to: Dr. Anil Agarwal, Type IV/48, SGPGIMS, Lucknow 226 014, India. Fax: +91 522 668017, 668047, 668078; E-mail: aagarwal{at}sgpgi.ac.in

Purpose: One hundred percent O₂ is used routinely for preoxygenation and induction of anesthesia. The higher the O₂ concentration the faster is the development of atelectasis, an important cause of impaired pulmonary gas exchange during general anesthesia (GA). We evaluated the effect of ventilation with 0.4 FIO₂ in air, 0.4 FIO₂ in N₂O and 100% O₂ following intubation on the development of impaired gas exchange.

Methods: Twenty-seven patients aged 18–40 yr, undergoing elective laparoscopic cholecystectomy were administered 100% O₂ for preoxygenation (three minutes) and ventilation by mask (two minutes). Following intubation these patients were randomly divided into three groups of nine each and ventilated either with 0.4 FIO₂ in air, 0.4 FIO₂ in N₂O or 100% O₂. Arterial blood gases were obtained before preoxygenation and 30 min following intubation for PaO₂ analysis. Subsequently PaO₂/FIO₂ ratios were calculated. Results were analyzed with Student’s t test and one-way ANOVA. P value of # 0.05 was considered significant.

Results: Ventilation of the lungs with O₂ in air (FIO₂ 0.4) significantly improved the PaO₂/FIO₂ ratio from baseline, while 0.4 FIO₂ in N₂O or 100% O₂ worsened the ratio (558 ± 47 vs 472 ± 28, 365 ± 34 vs 472 ± 22 and 351 ± 23 vs 477 ± 28 respectively; P < 0.05).

Conclusion: Ventilation of lungs with O₂ in air (FIO₂ 0.4) improves gas exchange in young healthy patients during GA.

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