Assistant Professor, Division of Dental Anesthesiology, Department of Science of Physical Functions, Kyushu Dental University, Fukuoka, Japan.
Lecturer, Division of Developmental Stomatognathic Function Science, Department of Health Promotion, Kyushu Dental University, Fukuoka, Japan.
J Oral Maxillofac Surg. 2021 Mar;79(3):539-545. doi: 10.1016/j.joms.2020.10.018. Epub 2020 Oct 16.
Upper airway obstruction (UAO) and oxygen desaturation are risk factors for major complications of intravenous sedation (IVS) in pediatric dental patients. This study aimed to investigate the use of a nasal high-flow (NHF) system for the prevention of UAO and oxygen desaturation in pediatric dental patients under IVS.
The authors implemented a prospective randomized design. Thirty pediatric patients (aged 3 to 12), scheduled for dental treatment under IVS, were enrolled in this study. The subjects were randomly assigned to 1 of 2 groups: patients who received oxygen at 5 L/minute through a nasal cannula (NC group) and patients who received oxygen at 2 kg/L/minute, up to a maximum of 30 L/minute, through the NHF system (NHF group). The predictor variable was flow rate. The primary outcome variable was the need for intervention during treatment, and the secondary outcome variable was the lowest peripheral capillary oxygen saturation values during the procedure. Additional study variables measured included patient age, gender, weight, height, and surgical duration. The Mann-Whitney U test and Fisher exact test were used for statistical analysis, with P < .05 considered as significant.
Both the NC (n = 15; mean age, 6.2 ± 2.3) and NHF (n = 15; mean age, 5.9 ± 2.5) groups had a male:female ratio of 2:1. The use of the NHF system significantly improved the lowest peripheral capillary oxygen saturation values during treatment (P < .05). Jaw lifting, to relieve UAO and facilitate spontaneous breathing, was required in both the NC (n = 10) and NHF (n = 3) groups (P < .05). The need for interventions during treatment was significantly lower in the NHF group (P < .05).
The results of this study suggest that the use of the NHF system can prevent UAO and improve the respiratory condition of pediatric dental patients under IVS.
上呼吸道阻塞（UAO）和氧饱和度降低是小儿牙科患者静脉镇静（IVS）主要并发症的危险因素。本研究旨在探讨在接受 IVS 的小儿牙科患者中使用鼻塞高流量（NHF）系统预防 UAO 和氧饱和度降低的效果。
作者采用前瞻性随机设计。纳入了 30 名（年龄 3 至 12 岁）计划接受 IVS 治疗的小儿患者，将其随机分为 2 组：通过鼻导管给予 5 L/分钟氧气的患者（NC 组）和通过 NHF 系统给予 2 kg/L/分钟、最高达 30 L/分钟氧气的患者（NHF 组）。预测变量为流量。主要结局变量为治疗期间的干预需求，次要结局变量为手术过程中的最低外周毛细血管血氧饱和度值。此外还测量了患者的年龄、性别、体重、身高和手术时间等研究变量。采用 Mann-Whitney U 检验和 Fisher 确切检验进行统计学分析，P<0.05 为差异有统计学意义。
NC 组（n=15；平均年龄 6.2±2.3 岁）和 NHF 组（n=15；平均年龄 5.9±2.5 岁）的男女比例均为 2:1。使用 NHF 系统显著改善了治疗期间的最低外周毛细血管血氧饱和度值（P<0.05）。NC 组（n=10）和 NHF 组（n=3）均需要抬起下颌以缓解 UAO 并促进自主呼吸（P<0.05）。NHF 组在治疗期间的干预需求明显更低（P<0.05）。
本研究结果表明，使用 NHF 系统可预防 UAO 并改善接受 IVS 的小儿牙科患者的呼吸状况。
