Abstract
BackgroundAirway management is a core clinical skill in anaesthesia. Pre-oxygenation prior to induction of anaesthesia is a standard practice to prevent desaturation. Apnoeic oxygenation in adults is effective and prolongs the time to desaturation. The effectiveness of apnoeic oxygenation in the adult is well documented; however, evidence in the paediatric is lacking. Therefore, the aim of this study was to investigate the effectiveness of apnoeic oxygenation during airway management in children.MethodsThis was a pilot randomised controlled trial. Patients were randomised to receive either apnoeic oxygenation or standard care during the induction of anaesthesia. The primary outcome was the duration of safe apnoea, defined as a composite of the time to first event, either time for SpO2 to drop to 92% or time to successfully secure the airway, and the lowest SpO2 observed during airway management. Secondary outcomes were the number of patients whose SpO2 dropped below 95% and the number of patients whose SpO2 dropped below 92%.ResultsA total of 30 patients were randomised, 15 to apnoeic oxygenation and 15 to standard care. No significant difference was observed in the time to first event (p = 0.870). However, patients randomised to apnoeic oxygenation had significantly higher SpO2 observed compared to the standard care group (p = 0.004). All patients in the apnoeic oxygenation group maintained SpO2 of 100% during airway management, compared to only six in the standard care group. SpO2 dropped below 92% in one patient, with the lowest SPO2 recorded 73%.ConclusionThis study suggests that providing 3 l/min oxygen by nasal cannula following pre-oxygenation contributes to maintaining high levels of oxygen saturation during airway management in children, contributing to increased patients’ safety during general anaesthesia.Trial registrationRetrospectively registered at ClinicalTrials.gov, NCT03271827. Registered: 4 September 2017.
Highlights
Airway management is a core clinical skill in anaesthesia
Sixty-three patients did not meet the eligibility criteria and nine patients declined to have their children participate in the study
Providing 3 l/min oxygen by nasal cannula following pre-oxygenation contributes to maintaining high levels of oxygen saturation during airway management in children
Summary
Airway management is a core clinical skill in anaesthesia. Pre-oxygenation prior to induction of anaesthesia is a standard practice to prevent desaturation. Apnoeic oxygenation in adults is effective and prolongs the time to desaturation. The aim of this study was to investigate the effectiveness of apnoeic oxygenation during airway management in children. It is necessary to manage patients’ ventilation and oxygenation (Hughes and Mardell 2012). During the intubation phase of airway management, patients are usually kept without ventilation and oxygenation until the airway is successfully secured (Wilkins et al 2009). This is called the apnoeic period (Hughes and Mardell 2012). Oxygen saturation gradually decreases as apnoea period during the airway management is prolonged (Wilkins et al 2009). Providing sufficient oxygen before attempting to secure the airway, known as pre-oxygenation, is a standard oxygenation method that sustains adequate oxygen saturation during airway management by denitrogenising the lungs, providing an oxygen reservoir which facilitates extended intubation (Tanoubi et al 2009)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
