在儿童喉镜检查中使用深部喉氧气灌输：一项随机临床试验。

Use of deep laryngeal oxygen insufflation during laryngoscopy in children: a randomized clinical trial.

机构信息

Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Centre and Children's Health, 1935 Medical District Drive, Dallas, TX 75235, USA Outcomes Research Consortium, Cleveland, OH, USA

Outcomes Research Consortium, Cleveland, OH, USA Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.

出版信息

Br J Anaesth. 2016 Sep;117(3):350-7. doi: 10.1093/bja/aew186. Epub 2016 Jul 27.

DOI:10.1093/bja/aew186

PMID:27466252

Abstract

BACKGROUND

Brief periods of haemoglobin oxygen desaturation are common in children during induction of general anaesthesia. We tested the hypothesis that oxygen insufflation during intubation slows desaturation.

METHODS

Patients 1-17 yr old undergoing nasotracheal intubation were enrolled and randomly assigned to one of three groups: standard direct laryngoscopy (DL); laryngoscopy with Truview PCD videolaryngoscope (VLO2); or laryngoscopy with an oxygen cannula attached to the side of a standard laryngoscope (DLO2). The co-primary outcomes were time to 1% reduction in [Formula: see text] from baseline, and the slope of overall desaturation vs time. All three groups were compared against each other.

RESULTS

Data from 457 patients were available for the final analysis: 159 (35%) DL; 145 (32%) DLO2; and 153 (33%) VLO2. Both VLO2 and DLO2 were superior to DL in both time to a 1% reduction in [Formula: see text] from baseline and the overall rate of desaturation (all P<0.001). The 25th percentile (95% confidence interval) of time to a 1% saturation decrease was 30 (24, 39) s for DL, 67 (35, 149) s for DLO2 and 75 (37, 122) s for VLO2. Mean desaturation slope was 0.13 (0.11, 0.15)% s(-1) for DL, 0.04 (0.02, 0.06)% s(-1) for DLO2 and 0.03 (0.004, 0.05)% s(-1) for VLO2. We did not find a correlation between decrease in [Formula: see text] percentage and BMI or age.

CONCLUSIONS

Laryngeal oxygen insufflation increases the time to 1% desaturation and reduces the overall rate of desaturation during laryngoscopy in children.

CLINICAL TRIAL REGISTRATION

NCT01886807.

摘要

背景

在全身麻醉诱导期间，儿童会出现短暂的血红蛋白氧饱和度降低。我们检验了这样一个假设，即插管期间的氧气吹入会减缓饱和度下降。

方法

纳入了 1 至 17 岁接受经鼻气管插管的患者，并将其随机分为三组：标准直接喉镜（DL）；Truview PCD 视频喉镜（VLO2）下的喉镜检查；或标准喉镜侧面连接氧气套管的喉镜（DLO2）。主要结果是从基线开始，[Formula: see text]下降 1%的时间，以及整体饱和度与时间的关系。将这三组与彼此进行比较。

结果

457 例患者的数据可用于最终分析：159 例（35%）为 DL；145 例（32%）为 DLO2；153 例（33%）为 VLO2。VLO2 和 DLO2 在从基线开始，[Formula: see text]下降 1%的时间和整体饱和度下降率方面均优于 DL（均 P<0.001）。DL 组饱和度下降 1%的第 25 百分位数（95%置信区间）为 30（24，39）s，DLO2 组为 67（35，149）s，VLO2 组为 75（37，122）s。DL 组平均饱和度下降斜率为 0.13（0.11，0.15）% s(-1)，DLO2 组为 0.04（0.02，0.06）% s(-1)，VLO2 组为 0.03（0.004，0.05）% s(-1)。我们没有发现[Formula: see text]百分比下降与 BMI 或年龄之间的相关性。