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Anesth Analg 2001;92:1337-1341
© 2001 International Anesthesia Research Society

GENERAL ARTICLES

Preoxygenation with Tidal Volume and Deep Breathing Techniques: The Impact of Duration of Breathing and Fresh Gas Flow

Usharani Nimmagadda, MD, Suvarchala D. Chiravuri, MD, M. Ramez Salem, MD, Ninos J. Joseph, BS, Yaser Wafai, MD, George J. Crystal, PhD, and Mohammad I. El-Orbany, MD

Department of Anesthesiology, Illinois Masonic Medical Center, Chicago, Illinois

Address correspondence and reprint requests to M. Ramez Salem, MD, Department of Anesthesiology, Illinois Masonic Medical Center, 836 W. Wellington Avenue, Chicago, IL 60657. Address e-mail to njoseph{at}immc.org


   Abstract
Top
 Abstract
Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Various techniques of "preoxygenation" before anesthetic induction have been advocated, including tidal volume breathing (TVB) for 3–5 min, four deep breaths (DB) in 0.5 min, and eight DB in 1 min. However, no study has compared the effectiveness of these techniques, assessed extending deep breathing beyond 1 min, or investigated the influence of fresh gas flow (FGF) in the same subjects using a circle absorber system. In 24 healthy adult volunteers breathing oxygen from a circle absorber system by tight-fitting mask, we compared TVB/5 min and deep breathing at a rate of 4 DB/0.5 min for 2 min at 5, 7, and 10 L/min FGF. Inspired and end-tidal respiratory gases were measured at 0.5-min intervals. During TVB, end-tidal oxygen (ETO2) increased rapidly and plateaued by 2.5 min at 86%, 88%, and 88% with 5, 7 and 10 L/min FGF, respectively. ETO2 values of >=90% were attained between 3 and 4 min. Four DB/0.5 min increased ETO2 to 75%, 77%, and 80% at 5, 7, and 10 L/min FGF. Eight DB/min resulted in ETO2 values of 82% and 87% at 7 and 10 L/min, respectively. Extending deep breathing to 1.5 and 2 min with 10 L/min FGF increased ETO2 by >=90%, although a decrease in ETCO2 was noted. We concluded that TVB/3–5 min was effective in achieving maximal "preoxygenation" whereas 4 DB/0.5 min resulted in submaximal "preoxygenation," and thus should be used only when time is limited. Increasing FGF from 5 to 10 L/min does not enhance "preoxygenation" with either TVB or 4 DB/0.5 min. Deep breathing yields maximal "preoxygenation" when extended to 1.5 or 2 min, and only when high (10 L/min) FGF is used.

Implications: Using a circle absorber system, normal breathing of oxygen for 3–5 min achieves optimal oxygenation of the lungs; whereas 4 deep breaths in 30 s does not. However, extending deep breathing to 1.5–2 min and using a high flow of oxygen improves oxygenation of the lungs to the same degree as normal breathing for 3–5 min. This may have important implications for patient safety.


   Introduction
Top
 Abstract
 Introduction
Materials and Methods
 Results
 Discussion
 References
 
Administration of oxygen before anesthetic induction and tracheal intubation (preoxygenation) is a widely accepted maneuver designed to increase oxygen reserves and thereby delay the onset of arterial hemoglobin desaturation of oxygen during apnea (1–3). This is particularly important when manually controlled ventilation is undesirable, as during rapid sequence induction of anesthesia or when difficult tracheal intubation and/or difficult ventilation are suspected (4).

Various techniques and regimens have been advocated to accomplish preoxygenation. Tidal volume breathing (TVB) of oxygen for 3–5 min has been commonly practiced (1,2). Gold et al. (5) challenged the need for 3 min of TVB (TVB/3 min) by demonstrating that four deep breaths (DB) within 0.5 min and TVB for 5 min (TVB/5 min) using a semiclosed circle absorber system were equally effective in increasing arterial oxygen tension (PaO2). Although some subsequent investigations corroborated their findings (6,7), others showed that TVB/3 min provided more effective preoxygenation, and longer protection against hypoxemia during apnea than the 4 DB/0.5 min method (8–11). Moreover, Baraka et al. (12) showed 8 DB/min at an oxygen flow of 10 L/min could produce PaO2 values comparable to that achieved with TVB/3 min and also delay the onset of apnea-induced hemoglobin desaturation of oxygen in comparison with TVB/3 min and 4 DB/0.5 min.

The inconsistent findings in the previous studies are likely attributable to methodological differences including those related to patient populations, various anesthetic systems (circle absorber (5–8), Mapleson A (11,13), Mapleson D (9–12), and nonrebreathing systems (2,10,14)) and widely varying fresh gas flows (FGFs) ranging from 4 L/min to 35 L/min (7,9). Because of the breathing characteristics of the circle absorber system (15), the minute ventilation during deep breathing may exceed the FGF and may result in rebreathing of exhaled gases at a smaller FIO2 than during TVB. Thus, the level of FGF may influence the effectiveness of preoxygenation, especially during deep breathing. There have been no studies comparing the effectiveness of the various techniques of preoxygenation and the influence of varying FGF in the same subjects using the circle absorber system. Accordingly, the current study was undertaken in adult healthy volunteers to compare the effectiveness of preoxygenation using TVB, 4 DB/0.5 min, and the newly described 8 DB/min methods, to assess the effect of extending the deep breathing technique to 1.5 and 2 min, and to investigate the influence of varying FGF on preoxygenation using the aforementioned techniques.


   Materials and Methods
Top
 Abstract
 Introduction
 Materials and Methods
Results
 Discussion
 References
 
After IRB approval, 24 consenting healthy ASA physical status I volunteers (14 men, 10 women) with a mean age (± SD) of 36 ± 8 yrs and a mean weight of 69 ± 13 kg, without history of lung or cardiac disease, were studied. The volunteers were nonbearded and nonsmoking operating room personnel recruited without inducement. They were allowed to eat a light breakfast on the day of the studies. The preoxygenation techniques were explained to the subjects and ample time was allowed for them to become familiar with mask breathing while maintaining a tight seal.

A single anesthesia machine (Model 210 Excel; Datex-Ohmeda, Madison, WI) was used throughout the studies. The circle absorber system consisted of an Ohmeda GMS (Gas Management System) absorber with barium hydroxide lime, USP (United States Pharmacopia) (Baralyme; Chemetron Medical Division, St. Louis, MO) absorbent, disposable 60-in corrugated breathing tubes, and a 3-L capacity natural latex breathing bag (King Systems, Noblesville, IN). The reservoir bag was fully inflated using the oxygen flush and partially occluding the mask. Preoxygenation was performed with 100% oxygen and a tight-fitting mask, with the subjects in the supine position. The following techniques were tested in each subject: 1) normal TVB for a 5-min period (TVB/5 min) and 2) DB for a 2-min period (4 DB/0.5 min, 8 DB/min, 12 DB/1.5 min & 16 DB/2 min). During TVB, the subjects were periodically reminded to maintain a normal tidal volume and a normal respiratory rate (RR). During DB, the subjects were prompted to breathe deeply at 7.5-s intervals. Each preoxygenation technique was tested using 5 L/min, 7 L/min, and 10 L/min FGF in each subject. The tests were performed in a randomized order with respect to technique and FGF using a computer-generated random assignment table. Data were collected during room air TVB (baseline) and at 0.5-min intervals during oxygen administration. Fifteen-min periods of room air breathing were allowed between tests.

Measured variables included inspired oxygen concentration (InspO2) and end-tidal oxygen concentration (ETO2), end-tidal nitrogen (ETN2), end-tidal carbon dioxide (ETCO2), and RR. Measurements were recorded using an Ohmeda Rascal II anesthetic and respiratory gas monitor (Datex-Ohmeda). Side-stream respiratory gases were sampled at a rate of 240 mL/min from a sampling port interposed between the filter and the Y-piece of the anesthetic circuit. Calibration with known gas mixtures was carried out according to the manufacturer’s specifications.

Survival statistics were applied to ETO2 versus time (washin) curves to determine differences between FGFs in reaching a target ETO2 >=90%. The Wilcoxon (Gehan) statistic and two-tailed probabilities were calculated and used for overall and pairwise comparisons of the washin curves. A one-way analysis of variance for repeated measurements was used to detect differences in responses as functions of FGF (5, 7, and 10 L/min) and time. After determining the time point at which ETO2 reached a plateau, the Student-Newman-Keuls test was used as a post hoc test. Individual Student’s t-tests were used to identify statistical differences between techniques (TVB versus DB) using pooled mean values at various time intervals. Statistical significance was accepted when P < 0.05. Values are reported as mean ± SD.


   Results
Top
 Abstract
 Introduction
 Materials and Methods
 Results
Discussion
 References
 
During TVB, the InspO2 remained unchanged during the 5-min periods of observation at all FGFs tested. During TVB with an FGF of 5 L/min, InspO2 (aggregate mean, 95.8%) was less than that seen with 7 and 10 L/min FGF (aggregate means, 98.1% and 98.4% for 7 and 10 L/min, respectively) ( Fig. 1). The InspO2 values during TVB using 7 and 10 L/min were not different from each other. During DB, InspO2 values increased significantly as FGF was increased from 5 to 7 and 10 L/min (aggregate means, 88.7%, 91.8%, and 95.1%, at 5, 7, and 10 L/min FGF, respectively. In addition, InspO2 increased significantly at 12 DB/1.5 min and 16 DB/2 min, as compared with 4 DB/0.5 min and 8 DB/min (Fig. 1).



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  		Figure 1. Comparison of tidal volume breathing (TVB) and deep breathing (DB) preoxygenation techniques on inspired oxygen using 5, 7, and 10 L/min fresh gas flow (FGF). *Significant difference between 5, 7 and 10 L/min FGF; {dagger}significant difference from DB at 0.5 and 1 min. Statistical significance accepted at P < 0.05.

 
During TVB, ETO2 increased rapidly between 0.5 and 2 min and plateaued by 2.5 min at 86.2 ± 4.5%, 88.1 ± 4.8%, and 87.7 ± 5.4% with 5, 7, and 10 L/min FGF, respectively ( Fig. 2). Mean ETO2 >=90% were reached between 3 and 4 min of TVB. The ETN2 decreased inversely ( Fig. 3). There were no changes in ETO2 or ETN2 between 2.5 and 5 min. During TVB, mean ETco2 and RR did not vary ( Fig. 4). There were no differences in ETO2, ETN2, ETCO2 or RR between 5, 7, and 10 L/min FGF during TVB (Figs. 2–4). In addition, pairwise survival analysis (volunteers reached a target ETO2 >=90% faster) revealed no differences among the three washin curves.



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  		Figure 2. Comparison of tidal volume breathing (TVB) and deep breathing (DB) preoxygenation techniques on end-tidal oxygen using 5, 7, and 10 L/min fresh gas flow (FGF). *Significant difference from deep breathing at 5 and 7 L/min FGF; {dagger}significant difference from DB at 0.5 and 1 min; {ddagger}Significant difference from TVB. Statistical significance accepted at P < 0.05.

 


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  		Figure 3. Comparison of tidal volume breathing (TVB) and deep breathing (DB) preoxygenation techniques on end-tidal nitrogen using 5, 7, and 10 L/min fresh gas flow (FGF). *Significant difference from deep breathing at 5 and 7 L/min FGF; {dagger}significant difference from DB at 0.5 and 1 min; {ddagger}significant difference from TVB. Statistical significance accepted at P < 0.05.

 


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  		Figure 4. Comparison of tidal volume breathing (TVB) and deep breathing (DB) preoxygenation techniques on end-tidal carbon dioxide using 5, 7, and 10 L/min fresh gas flow (FGF). {dagger}Significant difference from DB at 0.5 and 1 min. Statistical significance accepted at P < 0.05.

 
During DB, ETO2 increased steeply (as ETN2 decreased in a parallel fashion) to 75.2 ± 8.7%, 77.5 ± 5.6%, and 80.1 ± 4.6% at 4 DB/0.5 min using 5, 7, and 10 L/min FGF. These values did not differ from each other. With 5 L/min FGF, ETO2 did not change when DB was continued to 8 DB/min, 12 DB/1.5 min, or 16 DB/2 min (Fig. 2). With 7 and 10 L/min FGF, ETO2 continued to increase during extended DB, although much less steeply. At 8 DB/min, ETO2 increased with 7 and 10 L/min FGF to 82 ± 5% and 87 ± 3%, respectively. However, with 12 DB/1.5 min and 16 DB/2 min, ETO2 reached 90% or higher with 10 L/min FGF (Fig. 2). Pairwise survival analysis demonstrated that DB with 10 L/min FGF was superior (i.e., more volunteers reached a target ETO2 >=90% faster) compared with 5 and 7 L/min FGF.

Regardless of FGF and duration, DB resulted in higher ETO2 (and lower ETN2) in comparison with TVB/0.5 min and TVB/min. The value for ETO2 at 16 DB/2 min using 10 L/min was equivalent to TVB/3 min and TVB/3.5 min, but smaller than that with TVB/4 min to TVB/5 min (Figs. 2, 3).

During DB, ETCO2 decreased from a room air value of 40.4 ± 3.9 mm Hg to 36.1 ± 3.9, 33.8 ± 5.1, and 34.5 ± 5.2 mm Hg at 1.5 min using 5, 7, and 10 L/min FGF, respectively. At 16 DB/2 min, ETCO2 decreased to 34.2 ± 5.1, 32.4 ± 5.0, and 33.8 ± 4.9 mm Hg at 5, 7 and 10 L/min FGF, respectively (Fig. 4).

Both TVB and DB were well tolerated and acceptable to all volunteers. However, on ambulation, five subjects complained of transient dizziness and one subject complained of transient nausea, all after completion of 16 DB/2 min. There were no other complications related to the study.


   Discussion
Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
References
 
Previous studies on preoxygenation have focused on measurements of indices reflecting its efficacy and efficiency (16). Measurements of alveolar oxygenation (11,17,18), alveolar denitrogenation (19), or PaO2 (5,12,19,20) reflect the efficacy of preoxygenation, whereas the decline of hemoglobin saturation of oxygen during apnea is indicative of its efficiency. Because many factors can cause faster arterial hemoglobin desaturation of oxygen during apnea (3,5,13,21), the need to maximally preoxygenate before anesthetic induction and tracheal intubation is essential, especially in patients with oxygen transport limitations and those in whom difficult intubation and/or difficult ventilation are anticipated (15,22,23). Maximal preoxygenation is achieved when the alveolar, vascular (arterial and venous), and tissue compartments are all saturated with oxygen (16,24). Failure to breathe a high InspO2 (25), inadequate time for preoxygenation (16,17), and the presence of leak under the mask (3,11,26,27) can all result in submaximal alveolar oxygenation. In the current investigation, the volunteers received training in mask breathing beforehand, so as to avoid leaks, which influence InspO2 (3,11,26,27). Although various anesthetic systems can be used for preoxygenation, we studied the circle absorber because it is the system most frequently used in the operating room and it is as effective as other systems specifically designed for preoxygenation (25).

The end points of alveolar preoxygenation and denitrogenation have been defined as an ETO2 of approximately 90% and an ETN2 of 5% (9,17,18). Applying this criterion to our findings, it is obvious that at least 3 min of TVB is needed to achieve maximal preoxygenation. Increasing the FGF from 5 L/min to 10 L/min did not result in any faster increase in ETO2 or decline in ETN2 during TVB. This implies that when a circle absorber system is used, the resulting minor differences in InspO2 and nitrogen rebreathing with increasing FGF have no discernible impact on preoxygenation during TVB. This finding does not imply that using high FGF has no merit during preoxygenation. In clinical practice, it may somewhat compensate for any existing leak around the face mask (3,11,26,27).

Although not all previous studies are in agreement, most have found the 4 DB/0.5 min method of preoxygenation to be less effective than TVB for 2 min or longer. For example, two studies in parturients yielded conflicting results; one showed both techniques to be equally effective (6), whereas in the other 4 DB/0.5 min provided suboptimal alveolar oxygenation compared with TVB/2 min (11). In healthy patients, the times for arterial hemoglobin saturation of oxygen to decrease from 99%–100% to 97%, 95%, and 90% during apnea were found to be shorter after 4 DB/0.5 min compared with TVB/3 min (8). Investigations in elderly patients revealed that preoxygenation with TVB/3 min conferred longer protection against hypoxemia during prolonged apnea than did the 4 DB/0.5 min technique (9,10).

Our findings confirm that 4 DB/0.5 min provides suboptimal preoxygenation (no subject achieved ETO2 values >=90%), resulting in ETO2 values comparable to TVB/1.5–2 min, but less than that of TVB/2.5–5 min. Despite the increase in InspO2 concomitant with the increased FGF to 10 L/min, ETO2 was unaffected with the 4 DB/0.5 min method of preoxygenation. This finding may seem to be in conflict with that of a study (12) that suggested an exponential increase in PaO2 with 4 DB/0.5 min as FGF was increased from 5 L/min to 20 L/min using a Mapleson D system. However, such high FGFs are impractical because they exceed the limits of most anesthesia machines. Because 4 DB/0.5 min results in suboptimal preoxygenation with the commonly used FGFs in a circle absorber system, this technique should be used only in emergency situations where time is limited.

Our findings confirmed a previous observation (12) that extending DB to 8 DB/min improves preoxygenation, though ETO2 values did not reach 90%. They further suggest that extending the duration of DB to 12 DB/1.5 min or 16 DB/2 min enhances preoxygenation to ETO2 values >90%, especially when high FGF is used. Thus, it appears that increasing the FGF becomes effective in enhancing preoxygenation by minimizing nitrogen rebreathing only when the duration of DB is extended beyond 1 min.

Baraka et al. (12) found that the 8 DB/min method of preoxygenation delays the onset of apnea-induced hemoglobin desaturation of oxygen in comparison with TVB/3 min (12). Because a rapid sequence induction of anesthesia was performed in that study, oxygenation via a face mask was continued until apnea, a period of time described as 15–30 s during which an additional 3–4 breaths were administered (28). Although no arterial or ETCO2 measurements were obtained in their study, our findings during 12 DB/1.5 min and 16 DB/2 min suggest that hypocapnia may have occurred. Thus, the delayed onset of desaturation in this previous study may have reflected the leftward shift of the oxyhemoglobin dissociation curve rather than any real protection to the patient. Hypocapnia may have some other undesirable effects (29), including an increase in oxygen consumption (30) and cerebral vasoconstriction. Transient side effects presumably related to hypocapnia, including dizziness and nausea, were noted in our study in five volunteers after extended DB. Our data suggest that a 2-min period is the practical upper limit for DB and that, if extended beyond 2 min, DB may be associated with some undesirable side effects.

In conclusion, with the use of the circle absorber system, TVB for 3 to 5 min is effective in achieving maximal preoxygenation before induction of anesthesia. The 4 DB/0.5 min method results in suboptimal preoxygenation, and therefore should be reserved only for emergency situations where time is limited. Neither TVB nor the 4 DB/0.5 min method of preoxygenation is influenced by increasing the FGF. Although the 8 DB/min technique improves preoxygenation at higher FGFs, ETO2 values of >=90% are not attained. Extending the duration of DB to 1.5 or 2 min with a high FGF (10 L/min) further improves preoxygenation and yields ETO2 equivalent to TVB/3 min.


   References
Top
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

  1. Dillon JB, Darsie ML. Oxygen for acute respiratory depression due to administration of thiopental sodium. JAMA 1955; 159: 1114–6.
  2. Hamilton WK, Eastwood DW. A study of denitrogenation with some inhalation anesthetic systems. Anesthesiology 1955; 16: 861–7.[Web of Science][Medline]
  3. Drummond GB, Park GR. Arterial oxygen saturation before intubation of the trachea: an assessment of oxygenation techniques. Br J Anaesth 1984; 56: 987–92.[Abstract/Free Full Text]
  4. Preoxygenation: physiology and practice. Lancet 1992; 339: 31–2.[Web of Science][Medline]
  5. Gold MI, Duarte I, Muravchick S. Arterial oxygenation in conscious patients after 5 minutes and 30 seconds of oxygen breathing. Anesth Analg 1981; 60: 313–5.[Abstract/Free Full Text]
  6. Norris MC, Dewan DM. Preoxygenation for cesarean section: a comparison of two techniques. Anesthesiology 1985; 62: 827–9.[Web of Science][Medline]
  7. Goldberg ME, Norris MC, Larijani GE, et al. Preoxygenation in the morbidly obese: a comparison of two techniques. Anesth Analg 1989; 68: 520–2.[Free Full Text]
  8. Gambee AM, Hertzka RE, Fisher DM. Preoxygenation techniques: comparison of three minutes and four breaths. Anesth Analg 1987; 66: 468–70.[Free Full Text]
  9. Valentine SJ, Marjot R, Monk CR. Preoxygenation in the elderly: a comparison of the four-maximal-breath and three-minute techniques. Anesth Analg 1990; 71: 516–9.[Abstract/Free Full Text]
  10. McCarthy G, Elliott P, Mirakhur RK, McLoughlin C. A comparison of different pre-oxygenation techniques in the elderly. Anaesthesia 1991; 46: 824–7.[Web of Science][Medline]
  11. Russell GN, Smith CL, Snowdon SL, Bryson THL. Pre-oxygenation and the parturient patient. Anaesthesia 1987; 42: 346–51.[Web of Science][Medline]
  12. Baraka AS, Taha SK, Aouad MT, et al. Preoxygenation. Comparison of maximal breathing and tidal volume breathing techniques. Anesthesiology 1999; 91: 612–6.[Web of Science][Medline]
  13. Berthoud MC, Peacock JE, Reilly CS. Effectiveness of preoxygenation in morbidly obese patients. Br J Anaesth 1991; 67: 464–6.[Abstract/Free Full Text]
  14. McGowan P, Skinner A. Preoxygenation—the importance of a good face mask seal. Br J Anaesth 1995; 75: 777–8.[Abstract/Free Full Text]
  15. Eger EI II, Ethans CT. The effects of inflow, overflow, and valve placement on economy of the circle system. Anesthesiology 1968; 29: 93–100.[Web of Science][Medline]
  16. Benumof JL. Preoxygenation. Best method for both efficacy and efficiency? Anesthesiology 1999; 91: 603–5.[Web of Science][Medline]
  17. Berry CB, Myles PS. Pre-oxygenation in healthy volunteers—a graph of oxygen "washin" using end tidal oxygraphy. Br J Anaesth 1994; 72: 116–8.[Abstract/Free Full Text]
  18. Bhatia PK, Bhandari SC, Tulsiani KL, Kumar Y. End-tidal oxygraphy and safe duration in young adults and elderly patients. Anaesthesia 1997; 52: 175–8.[Web of Science][Medline]
  19. Carmichael FJ, Cruise CJE, Crago RR, Paluck S. Preoxygenation: a study of denitrogenation. Anesth Analg 1989; 68: 406–9.[Free Full Text]
  20. Archer GW, Marx GF. Arterial oxygen tension during apnoea in parturient women. Br J Anaesth 1974; 46: 358–60.[Abstract/Free Full Text]
  21. Baraka AS, Hanna MT, Jabbour SI, et al. Preoxygenation of pregnant and nonpregnant women in the head-up position versus supine position. Anesth Analg 1992; 75: 757–9.[Abstract/Free Full Text]
  22. Farmery AD, Roe PG. A model to describe the rate of oxyhaemoglobin desaturation during apnoea. Br J Anaesth 1996; 76: 284–91.[Abstract/Free Full Text]
  23. Benumof JL, Dagg R, Benumof R. Critical hemoglobin desaturation will occur before return to an unparalyzed state following 1 mg/kg intravenous succinylcholine. Anesthesiology 1997; 87: 979–82.[Web of Science][Medline]
  24. Campbell IT, Beatty PCW. Monitoring preoxygenation. Br J Anaesth 1994; 72: 3–4.[Free Full Text]
  25. Nimmagadda U, Salem MR, Joseph NJ, et al. Efficacy of preoxygenation with tidal volume breathing: comparison of breathing systems. Anesthesiology 2000; 93: 694–8.
  26. Berthoud M, Read DH, Norman J. Pre-oxygenation—how long? Anaesthesia 1983; 38: 96–102.[Web of Science][Medline]
  27. Mertzlufft F, Zander R. Optimal pre-oxygenation: the NasOral-system. Adv Exp Med Biol 1994; 345: 45–50.[Medline]
  28. Salem MR, Joseph NJ, Crystal GJ, Nimmagadda U. Preoxygenation: comparison of maximal breathing and tidal volume techniques [letter]. Anesthesiology 2000; 92: 1845–6.[Web of Science][Medline]
  29. Salem MR. Hypercapnia, hypocapnia, and hypoxemia. Semin Anesth 1987; 6: 202–15.
  30. Patterson RW. Effect of PaCO2 on O2 consumption during cardiopulmonary bypass. Anesth Analg 1976; 55: 269–73.[Abstract/Free Full Text]
Accepted for publication January 19, 2001.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins and Stanford University Libraries' HighWire Press®. Copyright 2001 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press