Abstract
BackgroundFailed airway management is the major contributor for anaesthesia-related morbidity and mortality. Cannot-intubate-cannot-ventilate scenarios are the most critical emergency in airway management, and belong to the worst imaginable scenarios in an anaesthetist’s life. In such situations, apnoeic oxygenation might be useful to avoid hypoxaemia. Anaesthesia guidelines recommend careful preoxygenation and application of high flow oxygen in difficult intubation scenarios to prevent episodes of deoxygenation. In this study, we evaluated the decrease in oxygen concentration in a model when using different strategies of oxygenation: using a special oxygenation laryngoscope, nasal oxygen, nasal high flow oxygen, and control.MethodsIn this experimental study we compared no oxygen application as a control, standard pure oxygen application of 10 l·min− 1 via nasal cannula, high flow 90% oxygen application at 20 l·min− 1 using a special nasal high flow device, and pure oxygen application via our oxygenation laryngoscope at 10 l·min− 1. We preoxygenated a simulation lung to 97% oxygen concentration and connected this to the trachea of a manikin model simulating apnoeic oxygenation. Decrease in oxygen concentration in the simulation lung was measured continuously for 20 min.ResultsOxygen concentration in the simulation lung dropped from 97 ± 1% at baseline to 40 ± 1% in the no oxygen group, to 80 ± 1% in the standard nasal oxygen group, and to 73 ± 2% in the high flow nasal oxygenation group. However, it remained at 96 ± 0% in the oxygenation laryngoscope group (p < 0.001 between all groups).ConclusionsIn this technical simulation, oxygenation via oxygenation laryngoscope was more effective than standard oxygen insufflation via nasal cannula, which was more effective than nasal high flow insufflation of 90% oxygen.
Highlights
Failed airway management is the major contributor for anaesthesia-related morbidity and mortality
Based on this and other studies, some authors postulated that the use of oxygenation laryngoscopes for the management of difficult airways might be an alternative to high flow oxygen insufflation devices [7]
The third was oxygen application via a special nasal cannula using a high flow oxygen insufflation device, and the fourth was via the oxygenating laryngoscope
Summary
Failed airway management is the major contributor for anaesthesia-related morbidity and mortality. Cannot-intubate-cannot-ventilate scenarios are the most critical emergency in airway management, and belong to the worst imaginable scenarios in an anaesthetist’s life In such situations, apnoeic oxygenation might be useful to avoid hypoxaemia. We have previously reported a newly designed dual-use laryngoscope [6], which may be an alternative system suitable for gas delivery into the deep laryngeal space in an unexpectedly difficult ventilation scenario in order to maintain apnoeic oxygenation. Based on this and other studies, some authors postulated that the use of oxygenation laryngoscopes for the management of difficult airways might be an alternative to high flow oxygen insufflation devices [7]. The oxygenation laryngoscope and high flow oxygen insufflation devices have not previously been compared
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