Multicentre study of preoxygenation practices by anaesthesia providers.

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Public Health

Background:

• Preoxygenation is a critical step in anesthesia induction to prevent hypoxemia.
• Practices and outcomes of preoxygenation can vary significantly across different healthcare settings and provider experience levels.
• Arterial oxygen desaturation during induction is a known risk factor for adverse perioperative events.

Purpose of the Study:

• To prospectively assess preoxygenation practices among anesthesia providers in Malaysian public hospitals.
• To determine the incidence of arterial oxygen desaturation during anesthesia induction.
• To identify factors associated with preoxygenation failure and desaturation, including provider specialty and surgical urgency.

Main Methods:

• Prospective observational study of 155 consecutive anesthetics in three Malaysian public hospitals.
• Data collection on preoxygenation administration by anesthesia providers.
• Monitoring and recording of arterial oxygen saturation during induction of anesthesia.
• Analysis of desaturation incidence based on surgical type (elective vs. emergency) and provider type (specialist vs. non-specialist).

Main Results:

• Preoxygenation was administered in 96.1% of cases.
• Overall incidence of arterial oxygen desaturation during induction was 15.5%.
• Desaturation was significantly higher in emergency surgery (30.2%) versus elective surgery (9.8%).
• Non-specialist providers had a higher rate of desaturation (18.9%) compared to specialists (3.0%).
• Failure to preoxygenate occurred in 8.8% of cases managed by specialists and 2.3% by non-specialists.

Conclusions:

• While preoxygenation is widely practiced, significant rates of arterial oxygen desaturation occur during anesthesia induction in Malaysian public hospitals.
• Emergency surgery and care by non-specialist anesthesia providers are associated with increased risk of desaturation.
• Targeted interventions and training may be necessary to improve preoxygenation techniques and reduce desaturation events, particularly in high-risk scenarios.