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Apneic oxygenation in pediatric anesthesia
Maren Kleine-Brueggeney1, Mareike Grosshauser2, Robert Greif3,4
1Department of Anaesthesia, University Children's Hospital Zurich - Eleonore Foundation, Zurich.
Insights
Apneic oxygenation in pediatric anesthesia extends safe apnea time but does not improve carbon dioxide elimination. Further research is needed on airway pressures and adverse effects in children.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Physiology
Background:
- Apneic oxygenation is a common technique in pediatric anesthesia.
- Understanding its effects on safe apnea time, CO2 elimination, and safety is crucial.
Purpose of the Study:
- To review current evidence on the pathophysiological aspects of apneic oxygenation in pediatric anesthesia.
- To evaluate its impact on safe apnea time, CO2 elimination, and potential adverse effects.
Main Methods:
- Literature review of studies on apneic oxygenation in pediatric anesthesia.
- Analysis of data on low vs. high flow oxygen delivery.
- Examination of effects on airway pressures and adverse events.
Main Results:
- Apneic oxygenation increases safe apnea time with both low and high flow oxygen.
- It does not enhance carbon dioxide elimination.
- Adverse effects like atelectasis and oxidative stress are not well-studied in pediatric patients.
Conclusions:
- Apneic oxygenation is primarily used for airway management in pediatric anesthesia.
- Carbon dioxide accumulation is a significant limitation.
- High flow nasal oxygen is more frequently used in spontaneously breathing children for airway interventions.
Purpose Of Review:
Apneic oxygenation is increasingly used in pediatric anesthesia. Its benefit for specific applications depends on the effect of apneic oxygenation on safe apnea time and carbon dioxide (CO2) elimination, on differences between low and high flow oxygen delivery, and on possible adverse effects. The present review summarizes current evidence on these pathophysiological aspects of apneic oxygenation as well as its applications in pediatric anesthesia.
Recent Findings:
Apneic oxygenation with both low flow and high flow nasal oxygen increases the safe apnea time, but does not lead to increased CO2 elimination. Airway pressures and adverse effects like atelectasis formation, oxidative stress and aerosol generation under apneic oxygenation are not well studied in pediatric anesthesia. Data from adults suggest no important effect on airway pressures when the mouth is open, and no significant formation of atelectasis, oxidative stress or aerosol generation with high flow nasal oxygen.
Summary:
Apneic oxygenation in pediatric anesthesia is mainly used during standard and difficult airway management. It is sometimes used for airway interventions, but CO2 accumulation remains a major limiting factor in this setting. Reports highlight the use of high flow nasal oxygen in spontaneously breathing rather than in apneic children for airway interventions.
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