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Preoxygenation before laryngoscopy in children: how long is enough?
J E Morrison1, E Collier, R H Friesen
1Department of Anesthesiology, Children's Hospital, Denver, CO 80218, USA.
Insights
Determining the ideal preoxygenation duration for pediatric laryngoscopy is crucial. This study found that most children achieve adequate oxygen levels within 100 seconds, establishing a benchmark for safe preoxygenation.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Physiology
Background:
- Preoxygenation is vital before pediatric laryngoscopy.
- The optimal duration for preoxygenation in children remains undefined.
Purpose of the Study:
- To determine the appropriate preoxygenation duration for infants and children undergoing laryngoscopy.
- To establish end-tidal oxygen (FE'O2) criteria for effective preoxygenation.
Main Methods:
- Healthy pediatric patients undergoing elective surgery were studied.
- Spontaneous breathing with a semiclosed circuit and 6 L/min oxygen flow was used.
- An end-tidal oxygen fraction (FE'O2) of 0.9 was the target endpoint.
Main Results:
- Fifty-eight children were analyzed; 6 did not meet the FE'O2 target.
- Preoxygenation times to reach FE'O2 of 0.9 varied by age, with older children requiring longer durations (e.g., >60 months: 68.4 ± 24.1 s).
- Logistic regression curves demonstrated the probability of achieving FE'O2 0.9 over time for each age group.
Conclusions:
- All children with a satisfactory mask fit achieved an FE'O2 of 0.9 within 100 seconds.
- This study provides evidence-based data to guide preoxygenation protocols in pediatric anesthesia.
- The findings support a preoxygenation duration of up to 100 seconds for pediatric patients.
Abstract:
The ideal preoxygenation period prior to laryngoscopy in children is unclear. This study was performed to determine an appropriate duration of preoxygenation for infants and children prior to laryngoscopy using endtidal oxygen (FE'O2) criteria. Healthy paediatric patients for elective day surgery procedures were studied. An inflatable mask connected to an oxygen-primed paediatric anaesthesia semiclosed circuit was placed on the face while patients breathed spontaneously during 6.min-1 oxygen flow. An FE'O2 of 0.9 was considered the endpoint, and if not achieved in two min the protocol was ended. Fifty-eight children were studied. Six patients never achieved an FE'O2 of 0.9 and were not considered in the analysis. The times (in seconds with mean +/- SD and range) to achieve a minimum endtidal (FE'O2) of 0.9 for under six months were 36 +/- 11.4(20-50), 7-12 months were 35.5 +/- 13.3(20-60), 13-36 months were 42.6 +/- 18.7(20-90), 37-60 months were 50.8 +/- 18.5(30-90), > 60 months were 68.4 +/- 24.1(30-100). Logistic regression curves were determined for each age group describing the probability of achieving an FE'O2 of 0.9 against time of preoxygenation. All children with satisfactory mask fit were able to preoxygenate to an FE'O2 of 0.9 within 100 s.