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Published on: October 11, 2011
Comparison of non-hypoxic apnea time in infants during induction of anesthesia with or without peep-A randomized
Sharmila Somayaji1, Nikhila Karanth2, Anuradha Ganigara3
1Department of Anesthesiology, Fortis Hospitals Limited, Bengaluru, Karnataka, India.
Insights
Positive end-expiratory pressure (PEEP) significantly prolonged non-hypoxic apnea time in infants during anesthesia induction. This ventilatory strategy is beneficial for infant respiratory physiology, increasing safe apnea duration.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Infants face higher risks of oxygen desaturation during anesthesia induction due to unique physiology.
- Positive end-expiratory pressure (PEEP) extends safe apnea time in adults, but infant data is limited and lacks rigor.
- This study addresses the need for rigorous investigation into PEEP's effects on infant apnea time.
Purpose of the Study:
- To investigate the impact of PEEP during anesthesia induction on non-hypoxic apnea time in infants.
- To determine if PEEP can prolong the duration of safe apnea in pediatric patients.
- To provide evidence for optimizing ventilatory strategies in infant anesthesia.
Main Methods:
- Seventy-two infants were enrolled and mechanically ventilated for three minutes.
- Infants received either 7 cmH2O PEEP or no PEEP (control group) during ventilation.
- Non-hypoxic apnea time was measured from ventilation cessation to SpO2 reaching 95%.
Main Results:
- The PEEP group (122 s) showed significantly longer non-hypoxic apnea time than the control group (95 s) (P=0.001).
- A statistically significant increase in apnea time was observed with increasing infant age.
- The findings demonstrate a clear benefit of PEEP in extending apnea duration.
Conclusions:
- Applying 7 cmH2O PEEP is an effective ventilatory strategy for infants undergoing anesthesia induction.
- PEEP helps mitigate adverse respiratory physiological changes during this critical period.
- This strategy enhances patient safety by increasing the window for intubation.
Background And Aims:
Infants are at the highest risk of oxygen desaturation during induction of anesthesia owing to their distinct anatomical and physiological characteristics. Prolongation of non-hypoxic safe apnea time by use of positive end expiratory pressure (PEEP) during induction has been studied extensively in adults. Although few studies have been conducted in infants, they lacked methodological rigor. Hence, we designed a scientifically rigorous study aimed at investigating the effects of application of PEEP during induction of anesthesia on the duration of non-hypoxic apnea time in infants.
Material And Methods:
Seventy-two infants were induced as per institutional protocol and mechanically ventilated for three minutes with volume-controlled ventilation and set ventilator parameters with PEEP of either 7 cm H2O or 0 cm H2O according to the group allocated, followed by endotracheal intubation. The duration of non-hypoxic apnea time, i.e., the duration from cessation of mechanical ventilation to the point when SpO2 reached 95%, was noted. Inferential statistics were done by using the independent 't' test, Mann Whitney test and Chi square test.
Results:
The duration of non-hypoxic apnea time was significantly longer in the PEEP group (n = 33) as compared to the control group (n = 33); 122 s (IQR = 52) vs. 95 s (IQR = 27) (P = 0.001) The duration of non-hypoxic apnea time increased significantly as the age of the infant increased.
Conclusions:
Addition of PEEP of 7 cmH2O is a useful ventilatory strategy in infants to offset undesired changes in the respiratory physiology during induction of anesthesia.
