프로포폴과 레미펜타닐을 이용한 감시마취에서 산소공급을 위해 사용하는 고유량 비강 캐뉼라와 단순 마스크의 효과 비교

Abstract

Background: Propofol and remifentanil is the most used combination in radiofrequency ablation (RFA) under monitored anesthesia care (MAC), but these has a serious problem as a respiratory depression. Some studies reported that high-flow nasal cannula (HFNC) can reduce hypoxic events during various procedures under sedation. In this study, we compare to the oxygenation contents and incidence of hypoxic event of simple face mask and HFNC for MAC in the patients undergoing RFA on hepatic neoplasm.

Methods: In this study, fifty-two patients were randomly allocated into two groups for elective RFA. Patients were received oxygen either simple face mask (Mask group) or HFNC (HFNC group). The primary outcomes were intraprocedural partial pressure of arterial oxygen (PaO2), pre- and intraprocedural differences in PaO2, and the incidence of hypoxic event. The secondary outcomes were intraprocedural the ratio of PaO2 to inspiratory oxygen fraction (FiO2) ratio (PaO2/FiO2), the difference of pre- and intraprocedural partial pressure of arterial carbon dioxide (PaCO2), respiration rate (RR) change during procedure, and patient’s satisfaction score after RFA

Results: Intraprocedural PaO2 and the difference of pre- and intraprocedural PaO2 were significantly different between two groups. Intraprocedural PaO2 of mask groups and HFNC were 199.9 (154.3 – 224.9) and 287.0 (191.3 – 379.9) mmHg, respectively (p = 0.009) and the differences of pre- and intraprocedural PaO2 of mask groups and HFNC were, 111.6 (67.4 – 141.8) and 188.5 (100.1 – 280.3) mmHg, respectively (p = 0.009l). The incidence of hypoxic event was not significantly different between two groups. (36% of mask group vs. 25.0% of HFNC group, respectively; p = 0.505). However, the incidence of severe hypoxic event was significantly lower in HFNC group than mask group. (32% of mask group vs. 4.2% of HFNC group, p = 0.045). Intraprocedural PaO2/FiO2 were significantly different between two groups. PaO2/FiO2 of mask group was significantly higher than HFNC group [399.9 (308.6 – 449.7) and 287.0 (191.3 – 379.9) mmHg, respectively (p = 0.005)]. RR was significantly different between two groups (F = 7.944; p = 0.08). There were significant differences in patient’s satisfaction score between two groups. Patients in mask group were more satisfied than HFNC group [60.6 (56.8 – 66) vs. 54.0 (44.0 – 62.0), respectively; p =0.031].

Conclusion: The use of HFNC improve oxygen profile and reduce the incidence of severe hypoxic event in patients undergoing percutaneous RFA under MAC with propofol-remifentanil.