Apneic Technique in Laryngotracheal Surgery.

Amy L Rutt,Paul Warner,Terrance Zimmermann,Jonathan E Charnin,Klaus D Torp,Roger Hofer,Dale Ekbom

doi:10.7759/cureus.21584

Abstract

BackgroundApneic oxygenation can be applied to select laryngotracheal procedures to improve operative visualization and avoid potential complications associated with intubation and jet ventilation. Aims/objectivesThe authors sought to determine if apneic oxygenation using a high-flow nasal cannula could be used as a safe alternative airway management strategy for the duration of select laryngotracheal procedures.MethodsSingle institution, multi-site retrospective review of 38 adult (>18 years old) patients undergoing apneic oxygenation in the setting of various laryngotracheal procedures from January 2017 through January 2018. Humidified oxygen was delivered via a high-flow nasal cannula. The data was collected and analyzed using SAS version 9.4 (SAS Institute, Cary, NC).ResultsTwenty-four women and 14 men, mean age 60.0 years (SD 16.1; 36-89) and 70.1 years (SD 7.2; 56-81), respectively, underwent a mean total apneic time of 23.9 minutes (13-40). A statistically significant correlation existed between apneic time and minimum oxygen saturation (Pearson correlation coefficient 0.38; p=0.018). Twenty-one patients resumed spontaneous ventilation without the need for jet ventilation, mask ventilation, or placement of a definitive airway during the procedure. Conclusions and significanceApneic oxygenation allows for extended periods of operating without the need for the placement of an endotracheal tube in patients undergoing general anesthesia for select laryngotracheal procedures.

Highlights

A primary goal during general anesthesia is the maintenance of adequate oxygenation
Apneic oxygenation allows for extended periods of operating without the need for the placement of an endotracheal tube in patients undergoing general anesthesia for select laryngotracheal procedures
After the induction of general anesthesia, while establishing an airway, there is a period of time known as the “apneic window” during which the patient is completely reliant upon the oxygen stores in the body - usually the functional residual capacity (FRC)

Summary

Introduction

A primary goal during general anesthesia is the maintenance of adequate oxygenation. After the induction of general anesthesia, while establishing an airway, there is a period of time known as the “apneic window” during which the patient is completely reliant upon the oxygen stores in the body - usually the functional residual capacity (FRC). The primary technique to accomplish an extended apneic window is through ample preoxygenation of the awake patient prior to induction of general anesthesia, typically via the use of a face mask delivering 100% oxygen [2]. With the continued delivery of oxygen during apnea, including via high-flow nasal cannula, a pharyngeal oxygen reservoir can be established, which will prolong safe apnea time even further [3]. The role of this high-flow nasal cannula technique as a primary means of maintaining adequate hemoglobin saturation, as opposed to a bridge to the establishment of a definitive airway, has not yet been reported in the United States. Apneic oxygenation can be applied to select laryngotracheal procedures to improve operative visualization and avoid potential complications associated with intubation and jet ventilation

Methods

Discussion

Conclusion