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Perioperative Medicine
Published in: Perioperative Medicine 1/2018

Open Access 01-12-2018 | Research

Apnoeic oxygenation by nasal cannula during airway management in children undergoing general anaesthesia: a pilot randomised controlled trial

Authors: Lafi Olayan, Abdulaleem Alatassi, Jaimin Patel, Sherran Milton

Published in: Perioperative Medicine | Issue 1/2018

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Abstract

Background

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 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.

Methods

This 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%.

Results

A 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%.

Conclusion

This 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 registration

Retrospectively registered at ClinicalTrials.​gov, NCT03271827. Registered: 4 September 2017.
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Metadata
Title
Apnoeic oxygenation by nasal cannula during airway management in children undergoing general anaesthesia: a pilot randomised controlled trial
Authors
Lafi Olayan
Abdulaleem Alatassi
Jaimin Patel
Sherran Milton
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Perioperative Medicine / Issue 1/2018
Electronic ISSN: 2047-0525
DOI
https://doi.org/10.1186/s13741-018-0083-x

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