Ventilation during total intravenous anaesthesia with ketamine

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Respiratory Physiology

Background:

• Total intravenous anaesthesia with ketamine (TIVAK) is a common anesthetic technique globally.
• While generally associated with preserved respiratory function, recent evidence suggests potential for desaturation during TIVAK.
• The impact of supplemental oxygen on preventing desaturation during TIVAK requires further investigation.

Purpose of the Study:

• To evaluate the effect of breathing room air versus 40% oxygen on arterial oxygen saturation during TIVAK.
• To compare the incidence and severity of desaturation events in adults and children receiving TIVAK with different oxygen concentrations.

Main Methods:

• A randomized controlled trial involving 76 adults and 64 children undergoing peripheral surgery.
• Participants were assigned to spontaneously breathe either room air or 40% oxygen during TIVAK.
• Continuous pulse oximetry monitoring was performed during anesthesia and recovery.

Main Results:

• Significantly fewer desaturations (SpO2 < 92%) occurred in adults receiving 40% oxygen compared to room air immediately after induction (3 vs. 20, P < 0.05).
• Two adults required tracheal intubation due to respiratory abnormalities in the room air group.
• Similar trends were observed in children, with lower and less severe desaturation rates in the oxygen group, none requiring intubation.

Conclusions:

• Supplemental oxygen administration is recommended for all adult patients during the initial 15 minutes of TIVAK to prevent arterial desaturation.
• The potential for significant desaturation necessitates trained personnel and readily available intubation equipment.
• Oxygen supplementation appears beneficial in pediatric patients, though less critical than in adults.