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Updated: Mar 17, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Use of deep laryngeal oxygen insufflation during laryngoscopy in children: a randomized clinical trial
J W Steiner1, D I Sessler2, N Makarova3
1Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Centre and Children's Health, 1935 Medical District Drive, Dallas, TX 75235, USA Outcomes Research Consortium, Cleveland, OH, USA jeffrey.steiner@utsouthwestern.edu.
Insights
Oxygen insufflation during pediatric intubation significantly slows desaturation. This method, using laryngeal oxygen insufflation (LOI), increases time to oxygen saturation decrease and reduces desaturation rates.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Physiology
- Medical Device Technology
Background:
- Hypoxemia during pediatric anesthesia induction is common.
- Nasotracheal intubation in children can lead to rapid oxygen desaturation.
- Investigating methods to mitigate desaturation during airway management is critical.
Purpose of the Study:
- To test if oxygen insufflation during laryngoscopy in children reduces the rate of oxygen desaturation.
- To compare standard direct laryngoscopy (DL) with videolaryngoscopy (VLO2) and direct laryngoscopy with oxygen insufflation (DLO2).
Main Methods:
- A randomized controlled trial involving 457 pediatric patients (1-17 years) undergoing nasotracheal intubation.
- Patients were assigned to DL, VLO2, or DLO2 groups.
- Co-primary outcomes: time to 1% oxygen saturation decrease and desaturation slope.
Main Results:
- Both VLO2 and DLO2 groups showed significantly longer time to 1% desaturation compared to DL (P<0.001).
- Desaturation slope was significantly lower in VLO2 and DLO2 groups versus DL (P<0.001).
- No correlation found between desaturation and BMI or age.
Conclusions:
- Laryngeal oxygen insufflation (LOI) during laryngoscopy in children effectively increases the time to oxygen desaturation.
- LOI reduces the overall rate of oxygen desaturation in pediatric patients.
- This technique offers a potential strategy to improve patient safety during anesthesia induction.
Background:
Brief periods of haemoglobin oxygen desaturation are common in children during induction of general anaesthesia. We tested the hypothesis that oxygen insufflation during intubation slows desaturation.
Methods:
Patients 1-17 yr old undergoing nasotracheal intubation were enrolled and randomly assigned to one of three groups: standard direct laryngoscopy (DL); laryngoscopy with Truview PCD videolaryngoscope (VLO2); or laryngoscopy with an oxygen cannula attached to the side of a standard laryngoscope (DLO2). The co-primary outcomes were time to 1% reduction in [Formula: see text] from baseline, and the slope of overall desaturation vs time. All three groups were compared against each other.
Results:
Data from 457 patients were available for the final analysis: 159 (35%) DL; 145 (32%) DLO2; and 153 (33%) VLO2. Both VLO2 and DLO2 were superior to DL in both time to a 1% reduction in [Formula: see text] from baseline and the overall rate of desaturation (all P<0.001). The 25th percentile (95% confidence interval) of time to a 1% saturation decrease was 30 (24, 39) s for DL, 67 (35, 149) s for DLO2 and 75 (37, 122) s for VLO2. Mean desaturation slope was 0.13 (0.11, 0.15)% s(-1) for DL, 0.04 (0.02, 0.06)% s(-1) for DLO2 and 0.03 (0.004, 0.05)% s(-1) for VLO2. We did not find a correlation between decrease in [Formula: see text] percentage and BMI or age.
Conclusions:
Laryngeal oxygen insufflation increases the time to 1% desaturation and reduces the overall rate of desaturation during laryngoscopy in children.
Clinical Trial Registration:
NCT01886807.
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