Apneic Oxygenation: A Method to Prolong the Period of Safe Apnea

A difficult intubation poses one of the most challenging tasks for anesthesia professionals, representing 27% of all adverse respiratory events, 93% of which are unanticipated. Unanticipated difficult mask ventilation and intubation may result in serious complications. Safe airway management requires a proper and thorough preoperative airway evaluation and a plan to secure the airway, with alternate plans available when the initial plan fails. Pediatric, obese, and obstetric patients undergoing general anesthesia with endotracheal intubation are considered to be at risk of rapid desaturation. As an adjunct to conventional preoxygenation techniques, continuous oxygen administration during the apneic period, termed apneic oxygenation, assists in the maintenance of oxygenation when tracheal intubation is attempted. Nine articles were selected for appraisal in this literature review: 6 randomized control trials, 2 prospective studies, and 1 retrospective study. Multiple apneic oxygenation techniques, including nasopharyngeal catheter, nasal prongs, endotracheal tube, intratracheal catheter, and high-flow transnasal humidified oxygen, demonstrated effectiveness at delaying the onset of hypoxemia during the apnea period. Prolonging the apneic window changes the nature of airway management in patients at high risk of desaturation and when an unanticipated difficult airway arises.