Low-flow apnoeic oxygenation for laryngeal surgery: a prospective observational study

Area of Science:

• Anesthesiology
• Otolaryngology
• Respiratory Physiology

Background:

• Laryngeal surgery demands optimal operating conditions, requiring close surgeon-anesthesiologist collaboration.
• Apnoeic oxygenation, while promising for maintaining oxygenation and minimizing laryngeal movement, has faced limitations due to concerns about carbon dioxide accumulation and acidaemia.

Purpose of the Study:

• To evaluate the efficacy of low-flow apnoeic oxygenation in maintaining oxygenation during microlaryngoscopy.
• To determine the rate of carbon dioxide accumulation during this technique.

Main Methods:

• A prospective study of 64 patients undergoing microlaryngoscopy under general anesthesia.
• Intraoperative oxygenation via a 10-French catheter delivering 0.5-1.0 L/min oxygen into the trachea.
• Monitoring of apnoea time, peripheral oxygen saturation, and venous blood gas concentrations.

Main Results:

• Mean apnoea duration was 18.7 minutes, with successful surgery in 62/64 patients.
• Mean rate of rise in venous partial pressure of carbon dioxide was 0.15 kPa/min.
• Adequate operating conditions were reported in all cases, with no adverse effects.

Conclusions:

• Low-flow intra-tracheal apnoeic oxygenation is a safe and effective method for maintaining oxygenation during laryngeal surgery.
• The technique facilitates successful surgical procedures with acceptable carbon dioxide levels.
• It presents a simple, effective, and inexpensive option for optimizing conditions in laryngeal surgery.