Olayan Lafi, Alatassi Abdulaleem, Patel Jaimin, Milton Sherran
1College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
2Department of Anesthesiology, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Perioper Med (Lond). 2018 Feb 21;7:3. doi: 10.1186/s13741-018-0083-x. eCollection 2018.
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.
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%.
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 ( = 0.870). However, patients randomised to apnoeic oxygenation had significantly higher SpO2 observed compared to the standard care group ( = 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 SPO recorded 73%.
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.
Retrospectively registered at ClinicalTrials.gov, NCT03271827. Registered: 4 September 2017.
气道管理是麻醉领域的一项核心临床技能。麻醉诱导前进行预充氧是预防血氧饱和度下降的标准操作。成人的无呼吸氧合有效，可延长血氧饱和度下降的时间。成人无呼吸氧合的有效性已有充分记录；然而，儿科方面的证据却很缺乏。因此，本研究的目的是探讨儿童气道管理期间无呼吸氧合的有效性。
这是一项初步的随机对照试验。患者在麻醉诱导期间被随机分为接受无呼吸氧合或标准护理。主要结局是安全无呼吸的持续时间，定义为首次事件的时间（即血氧饱和度降至92%的时间或成功建立气道的时间）与气道管理期间观察到的最低血氧饱和度的综合指标。次要结局是血氧饱和度低于95%的患者数量和血氧饱和度低于92%的患者数量。
共有30例患者被随机分组，15例接受无呼吸氧合，15例接受标准护理。首次事件的时间未观察到显著差异（P = 0.870）。然而，与标准护理组相比，接受无呼吸氧合的患者观察到的血氧饱和度显著更高（P = 0.004）。无呼吸氧合组的所有患者在气道管理期间血氧饱和度维持在100%，而标准护理组只有6例。1例患者的血氧饱和度降至92%以下，记录到最低血氧饱和度为73%。
本研究表明，预充氧后通过鼻导管提供3升/分钟的氧气有助于在儿童气道管理期间维持较高的血氧饱和度水平，从而提高全身麻醉期间患者的安全性。
在ClinicalTrials.gov上进行回顾性注册，NCT03271827。注册时间：2017年9月4日。
