Apnoeic oxygenation in paediatric anaesthesia: a narrative review

Lyons, Craig; Callaghan, M

doi:10.1111/anae.15107

Cited by 20 publications

(20 citation statements)

References 63 publications

(84 reference statements)

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“…We were unable to determine flow rates of the gases which could have had an impact on preoxygenation. This relates to anesthetic circuit flows and the use of nasal oxygen for apneic oxygenation techniques 10 . However, nasal high flow oxygen devices were only introduced into the hospital for research or general use from 2016, which is after our study period.…”

Section: Discussionmentioning

confidence: 99%

Incidence of post‐induction hypoxemia in children and the effect of induction gas composition

Cumin

Baker

Anderson

2021

Pediatric Anesthesia

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Background Pediatric preoxygenation and inhalation induction of anesthesia can include a mixture of gases. In children, the clinical impact on oxygenation while using other gases with oxygen during an inhalation induction is unknown. Aim We aimed to determine the impact of oxygen, nitrous oxide, and air concentrations added to the volatile agent by recording the incidence of hypoxemia following an inhalation gaseous induction in children. Method Records from an Automated Information Management System were used to find the incidence of hypoxemia following an inhalation induction of anesthesia. Episodes of hypoxemia (SaO2 < 90% sustained for at least 120 s) were recorded in the 10 min after the 3‐min induction period. Nitrous oxide and oxygen concentrations were recorded and nitrogen concentration was deduced. We also considered patient sex, age, and ASA status as covariates. Results A total of 27 258 cases were included in the analysis. The overall incidence of hypoxemia following an inhalation induction of anesthesia was 5.08% (95% CI 4.83 5.35). Hypoxemia was more common in younger patients and those with higher ASA scores. Controlling for those factors and sex, the incidence of hypoxemia increased 1.2‐fold when inspired oxygen concentration was less than 60% and hypoxemia was 2.37 times greater than the overall incidence when the inspired oxygen concentration was less than 40%. There was no clear effect of different concentrations of nitrous oxide or nitrogen when those were factored into the model. Conclusion The risk of hypoxemia following an inhalation induction of anesthesia in children is minimized when the inspired concentration of oxygen is greater than 60%.

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Section: Discussionmentioning

confidence: 99%

Incidence of post‐induction hypoxemia in children and the effect of induction gas composition

Cumin

Baker

Anderson

2021

Pediatric Anesthesia

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“…Apneic oxygenation (ApOx) refers to the passive movement of oxygen to the alveoli in the absence of lung movement by patient effort or positive pressure ventilation (8,(15)(16)(17). This technique has increased in popularity over the last ten years due to its ability to reduce desaturation during intubation in the ED and ICU, and in healthy patients undergoing elective surgery in adult studies (8,18,19).…”

Section: Introductionmentioning

confidence: 99%

“…This technique has increased in popularity over the last ten years due to its ability to reduce desaturation during intubation in the ED and ICU, and in healthy patients undergoing elective surgery in adult studies (8,18,19). This technique has also been implemented in obesity, obstetrics, and pediatrics (16,20). In a small number of pediatric studies in a non-RSII condition, ApOx could prolong safe apneic time and decrease the incidence of hypoxemia (21)(22)(23)(24).…”

Section: Introductionmentioning

confidence: 99%

Apneic oxygenation with low-flow oxygen cannula for rapid sequence induction and intubation in pediatric patients: a randomized-controlled trial

Aroonpruksakul¹,

Sangsungnern²,

Kiatchai³

2022

Transl Pediatr

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Background: Classical rapid sequence induction and intubation (RSII) is used to reduce pulmonary aspiration, but it increases the risk of hypoxemia. Apneic oxygenation (ApOx) has been studied to prolong safe apneic time, and to decrease the incidence of hypoxemia in adults. The aim of this study was to investigate the effectiveness of ApOx via low-flow nasal cannula to reduce the incidence of hypoxemia in pediatric rapid sequence induction.Methods: This prospective single-blind randomized controlled trial included patients aged 0-7 years, American Society of Anesthesiologists (ASA) physical status 1 to 3, who underwent elective or emergency surgery under general anesthesia with rapid sequence induction during February 2020 to March 2021.Participants were randomized to the ApOx group or the classical rapid sequence induction group. The ApOx group received oxygen flow via regular nasal cannula, as follows: 1 liter per minute (LPM) in age 0-1 month, 2 LPM in age 1-12 months, and 4 LPM in age 1-7 years. The classical group did not receive oxygen supplementation during intubation. The primary outcome was the incidence of hypoxemia, defined as oxygen saturation (SpO 2 ) ≤92%.Results: Sixty-four participants were recruited. The incidence of hypoxemia in both groups was 8 of 32 participants (25%) (P=1.000). Among desaturated patients, the median time to desaturation was 29.5 and 35 seconds in the ApOx and classical groups, respectively (P=0.527). The median lowest SpO 2 was 91% and 88.5% in the ApOx and classical groups, respectively (P=0.079). In non-desaturated patients, the median time to successful intubation was 40.5 and 35.5 seconds in the ApOx and classical groups, respectively (P=0.069). Conclusions:In this small sample study, ApOx using age-adjusted low-flow nasal cannula was ineffective for reducing the incidence of hypoxemia in pediatric RSII.

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“…Apnoeic oxygenation refers to oxygenation in the absence of spontaneous respiration or positive pressure ventilation. 16 The physiological principle underlying apnoeic oxygenation is aventilatory mass flow: in the apnoeic patient, as oxygen moves from the alveoli into the bloodstream, alveolar pressure becomes subatmospheric. 17 This in turn facilitates movement of oxygen (applied via nasal prongs) down a pressure gradient from the atmosphere into the alveoli.…”

Section: Introductionmentioning

confidence: 99%

A multicentre, randomised trial of stabilisation with nasal high flow during neonatal endotracheal intubation (the SHINE trial): a study protocol

et al. 2020

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IntroductionNeonatal endotracheal intubation is an essential but potentially destabilising procedure. With an increased focus on avoiding mechanical ventilation, particularly in preterm infants, there are fewer opportunities for clinicians to gain proficiency in this important emergency skill. Rates of successful intubation at the first attempt are relatively low, and adverse event rates are high, when compared with intubations in paediatric and adult populations. Interventions to improve operator success and patient stability during neonatal endotracheal intubations are needed. Using nasal high flow therapy extends the safe apnoea time of adults undergoing upper airway surgery and during endotracheal intubation. This technique is untested in neonates.Methods and analysisThe Stabilisation with nasal High flow during Intubation of NEonates (SHINE) trial is a multicentre, randomised controlled trial comparing the use of nasal high flow during neonatal intubation with standard care (no nasal high flow). Intubations are randomised individually, and stratified by site, use of premedications, and postmenstrual age (<28 weeks’ gestation; ≥28 weeks’ gestation). The primary outcome is the incidence of successful intubation on the first attempt without physiological instability of the infant. Physiological instability is defined as an absolute decrease in peripheral oxygen saturation >20% from preintubation baseline and/or bradycardia (<100 beats per minute).Ethics and disseminationThe SHINE trial received ethical approval from the Human Research Ethics Committees of The Royal Women’s Hospital, Melbourne, Australia and Monash Health, Melbourne, Australia. The trial is currently recruiting in these two sites. The findings of this study will be disseminated via peer-reviewed journals and presented at national and international conferences.Trial registration numberACTRN12618001498280.

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Apnoeic oxygenation in paediatric anaesthesia: a narrative review

Cited by 20 publications

References 63 publications

Incidence of post‐induction hypoxemia in children and the effect of induction gas composition

Incidence of post‐induction hypoxemia in children and the effect of induction gas composition

Apneic oxygenation with low-flow oxygen cannula for rapid sequence induction and intubation in pediatric patients: a randomized-controlled trial

A multicentre, randomised trial of stabilisation with nasal high flow during neonatal endotracheal intubation (the SHINE trial): a study protocol

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