Use of high-flow nasal oxygen in spontaneously breathing pediatric patients undergoing tubeless airway surgery: A prospective observational study

Abstract

The use of high-flow nasal oxygen is gaining popularity in apneic and spontaneously breathing adult patients during anesthesia. This prospective observational study evaluated the effect of high-flow nasal oxygen in maintaining adequate oxygenation and ventilation in spontaneously breathing pediatric patients with dynamic airway obstruction, undergoing tubeless airway surgery.Oxygenation was provided via an age-appropriate, high-flow nasal cannula at a flow rate of 2 L kg −1 min −1 . Propofol and remifentanil were used to maintain anesthesia while preserving spontaneous respiration. We sought to determine the incidence and risk factors of rescue ventilation. Rescue ventilation with a face mask was performed when the pulse oximetry oxygen saturation was <90% or transcutaneous carbon dioxide was >80 mm Hg.In total, 27 patients were included in the final analysis. Median (interquartile range) of pulse oximetry and transcutaneous carbon dioxide were 100% (99%-100%) and 58.4 mm Hg (51.4-70.3 mm Hg), respectively. Altogether, 9 (33.3%) patients needed rescue ventilation during anesthesia. Of these, 7 patients (25.9%) developed oxygen desaturation (<90%) and 2 patients (7.4%) developed hypercarbia. Patients who required rescue ventilation were significantly younger (8.2 vs 28.8 months, P = .02) and required a longer anesthesia time (55.7 vs 41.0 minutes, P = .04) than those who did not.In conclusion, High-flow nasal oxygen is an alternative technique to maintain oxygenation in children undergoing airway surgeries. However, younger age and longer anesthesia time are significant risk factors leading to the requirement of rescue ventilation in these patients. Further studies with large sample size are required for clinical application of these techniques.Abbreviations: CI = confidence interval, FiO 2 = fraction of inspired oxygen, IQR = interquartile range, ORI = oxygen reserve index, TcCO 2 = transcutaneous carbon dioxide.

Endoscopic surgery under tubeless anesthesia and spontaneous breathing for a congenital laryngeal web in an infant: A case report

“…However, in pediatric patients, tubeless anesthesia can carry the risk of rescue ventilation when the pulse oximetry oxygen saturation is <90% or transcutaneous carbon dioxide is >80 mmHg; moreover, this risk increases in cases of prolonged surgical procedures. High‐flow nasal oxygen, or oxygen delivered through a tube positioned through a nostril into the hypopharynx under endoscopic guidance has been proven as an alternative technique to maintain oxygenation in children undergoing airway surgeries 9 ; the second option was adopted in the present case, and the entire procedure lasted about 30 min, with no episodes of desaturation or hypercarbia reported, so there was no need for any rescue ventilation or endotracheal intubation during the entire procedure.…”

Safe use of high flow nasal oxygen in apnoeic patients for laryngotracheal surgery

“…28 We believe that HFNO-ap in laryngotracheal surgery offers a number of specific advantages over existing alternative oxygenation techniques, albeit patient and pathophysiology dependent: it provides a superior operative field to a microlaryngoscopy tube, jet ventilation catheter or Tritube (Ventinova Medical, Eindhoven, Netherlands); it avoids the risks of a high-pressure system and motion artefact associated with supraglottic high pressure jet ventilation; it necessitates fewer procedural interruptions than an intermittent facemask ventilation technique; and, reduced equipment requirements and the need for operator understanding compared with jet ventilation or Tritube. HFNO-sv during laryngotracheal surgery (sometimes referred to as SponTaneous Respiration using IntraVEnous anaesthesia, 'STRIVE Hi') has been described in adults 29 and children, 30 though reported case numbers are limited, and it is not the preferred technique at our institutions and is therefore not considered here.…”

Oxygen reserve index versus conventional peripheral oxygen saturation for prevention of hypoxaemia

“…However, hypoxaemia is observed frequently despite these efforts. 1,2 The oxygen reserve index (ORI), measured using the rainbow Pulse CO-Oximetry sensor and Radical-7 Pulse CO-Oximeter (Masimo, Irvine, California, USA), is a noninvasive parameter that reflects the oxygen reserve capacity of the patient. As the ORI depends on the level of arterial oxygen partial pressure (P a O 2 ), its value can range between 0 and 1.0 when the oxygen saturation is at 100%.…”

“…Various interventions, such as the maintenance of spontaneous respiration, administration of high-flow O 2 , or use of tracheal intubation, have been used, when necessary, to ensure adequate oxygenation during airway surgery. However, hypoxaemia is observed frequently despite these efforts 1,2 …”