胖子在插管時就算用RSI，沒有呼吸，但給5L/min O2仍可以延長90秒的desaturraiton, 另根據2005年，最好head up 25度

Oxygenation During Apnea Prolongs Time to Desaturation in Obese Patients

Oxygen administration delayed oxyhemoglobin desaturation to 95% by 1.5 minutes in obese patients undergoing elective surgery.

Obese patients experience more-rapid hemoglobin desaturation during apnea than nonobese patients. In a randomized controlled trial, researchers evaluated the effect of oxygen administration during simulated difficult laryngoscopy on duration of desaturation in 30 obese (body-mass index, 30–35 kg/m2) men undergoing elective surgery. After preoxygenation and intravenous induction of anesthesia with neuromuscular blockade in all patients, half the patients received supplemental nasal oxygen via nasal prongs at a rate of 5 L/minute. Difficult laryngoscopy was simulated by gentle insertion of the laryngoscope and visualization of the larynx, with delay of tracheal intubation until 6 minutes after succinylcholine administration or when arterial oxygen saturation (SpO2) decreased to 95%.

Patients who received oxygen during apnea maintained SpO2 ≥95% for significantly longer than controls (5.29 vs. 3.49 minutes) and had significantly greater mean SpO2 nadir (94.3% vs. 87.7%). Time to resaturation to an SpO2 of 100% after initiation of ventilation with 100% oxygen did not differ significantly between groups.

Comment: Administration of oxygen during apnea prolonged time to desaturation, presumably via passive air movement from upper airways to the alveoli. Because nasal cannulae do not interfere with any aspect of laryngoscopy or intubation, this practice should be routine in obese patients, who also should be preoxygenated in an upright position, if possible (JW Emerg Med Jul 26 2005). Supplemental nasal oxygen should be considered in children (who also desaturate rapidly) and perhaps in patients with anticipated difficult intubation, even if they are not obese.

— Emily L. Brown, MD, and Ron M. Walls, MD, FRCPC, FAAEM

Published in Journal Watch Emergency Medicine June 11, 2010
Citation(s):

Ramachandran SK et al. Apneic oxygenation during prolonged laryngoscopy in obese patients: A randomized, controlled trial of nasal oxygen administration. J Clin Anesth 2010 May; 22:164.

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