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Topical Airway Anesthesia for Awake-endoscopic Intubation Using the Spray-as-you-go Technique with High Oxygen Flow
Published on: January 13, 2017
Low-flow oxygen delivery using a nasal cannula for apnoeic oxygenation in children undergoing elective surgery under
Sohini Ray1, Anju R Bhalotra1, Mona Arya1
1From the Department of Anaesthesiology & Intensive Care, Maulana Azad Medical College and Associated Hospitals (SR, ARB, MA) and Department of Anaesthesiology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India (KRS).
Insights
Apnoeic oxygenation with a nasal cannula effectively prevented oxygen desaturation in children during intubation. This method maintained higher oxygen saturation levels compared to the control group, ensuring patient safety.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Physiology
- Critical Care Medicine
Background:
- Children are at higher risk of hypoxemia during apnea due to smaller lung volumes and higher metabolic rates.
- The efficacy of apnoeic oxygenation in pediatric patients undergoing laryngoscopy and intubation remains under-investigated.
Purpose of the Study:
- To evaluate the effectiveness of nasal cannula apnoeic oxygenation in preventing oxygen desaturation in children during laryngoscopy and intubation.
- To compare peripheral oxygen saturation (SpO2) levels between children receiving apnoeic oxygenation and a control group.
Main Methods:
- A prospective, randomized, double-blind controlled trial was conducted with 120 children aged 1-6 years.
- Participants were assigned to receive either 3 L/min oxygen via nasal cannula (apnoeic oxygenation group) or no oxygen (control group).
- Lowest SpO2 during laryngoscopy and intubation was the primary outcome; secondary outcomes included SpO2 drops and bradycardia incidence.
Main Results:
- The apnoeic oxygenation group maintained significantly higher lowest SpO2 (99.95% ± 0.29%) compared to the control group (98.37% ± 4.60%; P=0.009).
- No patient in the apnoeic oxygenation group experienced SpO2 fall, despite longer apnea times (P=0.012).
- In the control group, 4 patients had SpO2 fall below 92% (P=0.038), and no bradycardia was observed in either group.
Conclusions:
- Apnoeic oxygenation via nasal cannula is an effective strategy to prevent oxygen desaturation in pediatric patients during laryngoscopy and intubation.
- This intervention significantly improves oxygenation safety in children undergoing airway procedures under general anesthesia.
Background:
Children have a smaller functional residual capacity and higher rate of oxygen consumption making them prone to develop hypoxaemia during a period of apnoea. The effectiveness of apnoeic oxygenation in preventing oxygen desaturation during laryngoscopy and intubation in small children has not been well studied.
Objective:
To assess the effectiveness of apnoeic oxygenation using a nasal cannula in preventing oxygen desaturation during laryngoscopy and intubation in children.
Design:
Prospective randomised double-blind controlled trial.
Setting:
Tertiary care teaching hospital between January 2020 and September 2021.
Patients:
One hundred and twenty children of 1 to 6 years age undergoing elective surgery requiring general anaesthesia with endotracheal intubation.
Intervention:
Patients were randomly allocated to receive 3 l min-1 oxygen by nasal cannula (apnoeic oxygenation group) or no oxygen (control group). Laryngoscopy and intubation was undertaken by a trainee anaesthesiologist.
Main Outcome Measures:
The primary outcome was the lowest value of peripheral oxygen saturation (SpO2) during laryngoscopy and intubation. Secondary outcomes were the number of children whose SpO2 dropped to 95%, from 92% to < 95%, and below 92% and the incidence of bradycardia.
Results:
The mean ± SD of lowest SpO2 values was 99.95 ± 0.29% in the apnoeic oxygenation group and 98.37 ± 4.60% in the control group (P = 0.009). No fall of SpO2 occurred in any patient in the apnoeic oxygenation group in spite of a longer apnoea time (P = 0.012). In the control group, 43 patients had no fall in SpO2 (P < 0.001), in 12 patients there was a fall in SpO2 to 95% (P = 0.004), in one patient SpO2 fell to 92 to <95% (P = 0.315) and in four patients SpO2 fell below 92% (P = 0.038). There was no incidence of bradycardia.
Conclusion:
Apnoeic oxygenation using a nasal cannula was effective in preventing oxygen desaturation during laryngoscopy and intubation in children as compared with those who did not receive apnoeic oxygenation.
Trial Registration:
Clinical Trials Registry of India: CTRI/2020/01/022724 (www.ctri.nic.in).
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