Document Type

DNP Project

Publication Date

9-1-2020

Disciplines

Nursing

Abstract

Patients with class three obesity, formerly defined as morbid or extreme obesity, presenting for anesthesia come with an increased risk of experiencing complications. The oxygen storage capabilities and the functional residual capacity (FRC) in the lungs are reduced, making this patient population at risk for rapid oxygen desaturation with apnea. This patient population also has an increased risk for complications to occur while securing the patient’s airway during induction of anesthesia and are at risk for difficult airway management. Preoxygenation is performed before the induction of anesthesia to replace nitrogen in the lungs with oxygen, this will increase the time a patient can tolerate apnea without desaturating. Due to the increased risks which present with the class three obesity population, it is important to optimize preoxygenation prior to the induction of anesthesia and to consider providing apneic oxygenation during the intubation process to prevent desaturation. There are many studies and recommendations found in the literature concerning optimizing preoxygenation, patient positioning, and providing apneic oxygenation to the class three obesity patient population as means to prevent desaturation during induction of anesthesia. The objective of this project was to utilize the Iowa Model of Research-Based Practice to Promote Quality Care (IOWA Model) to perform a review of the literature concerning preoxygenation of obese patients and examine current preoxygenation practices at Hendricks Regional Health Hospital (HRH). Current practice at HRH was examined via retrospective chart review of three months of data. During September, October, and November of 2019, HRH had 82 patients with a BMI of 40 or greater receive anesthesia which required endotracheal tube (ETT) placement for airway management. 16 (20%) of these patients experienced a desaturation measured by a peripheral capillary oxygen saturation (SpO2) less than 90%. Data extracted from the retrospective chart review produced descriptive as well as parametric statistics. The results of the data analysis did not offer significant results identifying differences between the group of patients who experienced a desaturation and the group of patients who did not have a desaturation. Because of this, it is suggested each patient at risk for desaturation, including those with class three obesity, be treated as though they are going to experience a desaturation and measures to prevent this desaturation be taken. Techniques to decrease the percentage of patients who experiencing a desaturation during the induction of anesthesia at HRH are discussed in this paper.

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