Summary of presentation by Dr Molloy at Armstrong Medical POINT® in Practice Seminar, Coleraine Northern Ireland October 2018.
SCD is the provision and delivery of oral healthcare to patients with a wide range of disabilities. Patients tend to not access healthcare, have increased comorbidities and worse outcomes.
General anaesthesia (GA) may be needed to facilitate patient co-operation rather than facilitate the surgical procedure, and in these circumstances it is often a complex undertaking that requires careful consideration.
Recent guidelines recommend use of IV sedation wherever possible to avoid the problems associated with GA, and supplemental oxygen is usually required in these procedures.
Use of High Flow Nasal Oxygen Therapy (HFNOT) improves oxygenation, creates positive airway pressure effects, and improves patient comfort whilst allowing deeper levels of sedation to be used without causing hypoxia.
Use of POINT High Flow system allows air blending and reduction in FiO2 so that patients are not exposed to prolonged sedation with 100% O2 and can be used to good effect in difficult patients, obese patients and known difficult airways.
Effects on practice: increase in number of patients being treated as day cases and use of IV sedation, with a reduction in the number of GAs being given and unplanned admissions post procedure. Use of POINT® and IV sedation is now the preferred choice in higher risk cases
Take home message: use of POINT® in SCD allows deeper sedation to be used more safely and frequently in complex and high risk patients.
Maintaining adequate oxygenation is a peri-operative challenge.
Difficult tracheal intubations with multiple laryngoscopy-hypoxia-reoxygenation cycles can lead to a “can’t intubate, can’t ventilate” scenario.
Post-operative pulmonary complications
Anaesthesia may adversely affect the lungs’ defence mechanisms impairing the ability to cough and suppressing mucociliary clearance. Post-operative pulmonary complications (PPC) are linked to increased length of stay and mortality.
Cardiac, thoracic and abdominal surgery present the highest risk of PPC.(1)
On POINT with Armstrong Medical
With 30 years experience in airway management & respiratory consumables Armstrong Medical’s POINT range provides three levels of respiratory support;
- Nasal High Flow (NHF)
- Combined NHF and PEP
- High flow CPAP
Both the MaxVenturiTM 120 and FD140 are ideal for NHF, difficult airway and post-operative applications.
(1)Canet J et al, Predication of postoperative pulmonary complications in a population – based surgical cohort. Anaesthesiology,(2010) 113 1-6 A.Patel S.A.R Nouaei, Transnasal Humidified Rapid insufflation Ventilatory exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways, Anesthesia 70, 323-329 (2015).