Pharyngeal Oxygen Insufflation During AirTraq Laryngoscopy Slows Arterial Desaturation in Infants and Small Children.

Abstract

The extent to which insufflation of oxygen into the posterior pharynx during laryngoscopy prolongs adequate saturation in infants and small children remains unknown. Therefore, we compared oxygen saturation over time in preoxygenated small children with and without posterior pharynx oxygen insufflation. After induction of anesthesia with sevoflurane and propofol, infants and small children were preoxygenated with 100% oxygen for 3 minutes. An AirTraq laryngoscope size 0 or 1 with an appropriately sized cuffed endotracheal tube positioned in the side channel was prepared. Oxygen tubing was connected to the endotracheal U-shaped tube. However, oxygen at a flow of 4 L/min was provided only to half of the randomly selected participating patients. The trachea was intubated, the tube cuff was inflated, and the laryngoscope was removed from the mouth. The oxygen tubing was disconnected from the endotracheal tube and left exposed to ambient air until oxygen saturation decreased to 95%. Thereafter, patients' lungs were manually ventilated with 100% oxygen until SpO2 returned to 100%. Subsequent anesthetic management was at the discretion of the attending anesthesiologist. Laryngoscopy took a median of 60 (Q1-Q3, 40-90) seconds. The mean time to 95% oxygen saturation was (mean ± SD) 166 ± 47 seconds in the oxygen insufflation group and 131 ± 39 seconds in small children without insufflation. Oxygen insufflation prolonged the mean time for saturation to decrease from 100% to 95% by an estimated 35 (95% confidence interval, 10-60) seconds, P = 0.01. Adding posterior pharyngeal oxygen insufflation to conventional preoxygenation prolonged the period of adequate oxygen saturation in infants and small children by an amount that is potentially clinically important.