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Preinduction incentive spirometry versus deep breathing to improve apnea tolerance during induction of anesthesia in patients of abdominal sepsis: a randomized trial
Tripathi M, Subedi A, Raimajhi A, Pokharel K, Pandey M
Journal of Postgraduate Medicine 2013 Oct-Dec;59(4):275-280
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Abdominal sepsis is associated with varied degree of hypoxemia and atelactasis in the lung and can enhance the onset of desaturation of arterial blood during apnea. AIMS: This study looked at methods to improve safety margin of apnea during induction of anesthesia in these high-risk patients. SETTINGS AND DESIGN: It was a randomized, single blind study on adult patients presenting for emergency laparotomy due to peritonitis in a university teaching hospital setting. MATERIALS AND METHODS: In group 1 (IS) (n = 32), three sessions of incentive spirometry (IS) were performed within one hour before induction of anesthesia. In group 2 (DB) (n = 34), patients were subjected to deep breathing sessions in a similar manner. All patients received preoxygenation (100%) by mask for 3 min, followed by rapid-sequence induction of anesthesia using fentanyl, thiopental, and suxamethonium and endotracheal intubation. Patients were subjected to a period of apnea by keeping the end of the endotracheal tube open to air till they developed 95% hemoglobin saturation (SpO2) by pulse oxymetry. Positive pressure ventilation was resumed at the end. We observed for hemodynamic changes, apnea time, and SpO2 (100%) recovery time on resuming ventilation. Arterial blood gas samples were taken before intervention, after IS or DB, after preoxygenation, and at the end of apnea. Statistical analysis used: One-way analysis of variance (ANOVA), Chi2 test, Kaplan-Meier graph, and log-rank tests were applied to compare the two study groups. RESULTS: Oxygenation level in group 1 (265 +/- 76.7 mmHg) patients was significantly (p < 0.001) higher than in group 2 (221 +/- 61.8 mmHg) at the end of preoxygenation. The apnea time (median: lower bound to upper bound confidence interval apnea time) (272: 240 to 279 s) in group 1 (IS) patients was significantly higher p < 0.05) than in group 2 (180: 163 to 209 s) patients. Saturation recovery time (35: 34 to 46 s) in group 1 (IS) patients was also quicker than in group 2 patients (48: 44 to 58 s). CONCLUSIONS: IS in the preoperative period is superior to deep breathing sessions for improving apnea tolerance during induction of anesthesia in abdominal sepsis patients.

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