Aroonpruksakul Naiyana, Sangsungnern Peerapong, Kiatchai Taniga
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Transl Pediatr. 2022 Apr;11(4):427-437. doi: 10.21037/tp-21-484.
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.
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) ≤92%.
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 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).
In this small sample study, ApOx using age-adjusted low-flow nasal cannula was ineffective for reducing the incidence of hypoxemia in pediatric RSII.
Thai Clinical Trials Registry TCTR20210802002.
经典的快速顺序诱导插管（RSII）用于减少肺误吸，但会增加低氧血症风险。已对无氧通气（ApOx）进行研究，以延长安全无氧时间，并降低成人低氧血症的发生率。本研究旨在探讨经低流量鼻导管进行ApOx对降低小儿快速顺序诱导中低氧血症发生率的有效性。
这项前瞻性单盲随机对照试验纳入了年龄在0至7岁、美国麻醉医师协会（ASA）身体状况为1至3级、于2020年2月至2021年3月期间在全身麻醉下接受择期或急诊手术并采用快速顺序诱导的患者。参与者被随机分为ApOx组或经典快速顺序诱导组。ApOx组通过常规鼻导管吸氧，如下：0至1个月龄者为每分钟1升（LPM），1至12个月龄者为2 LPM，1至7岁者为4 LPM。经典组在插管期间不吸氧。主要结局是低氧血症的发生率，定义为血氧饱和度（SpO）≤92%。
招募了64名参与者。两组中低氧血症的发生率均为32名参与者中的8名（25%）（P = 1.000）。在血氧饱和度降低的患者中，ApOx组和经典组血氧饱和度降低的中位时间分别为29.5秒和35秒（P = 0.527）。ApOx组和经典组最低SpO的中位数分别为91%和 88.5%（P = 0.079）。在未出现血氧饱和度降低的患者中，ApOx组和经典组成功插管的中位时间分别为40.5秒和35.5秒（P = 0.069）。
在这项小样本研究中，使用年龄调整后的低流量鼻导管进行ApOx对降低小儿RSII中低氧血症的发生率无效。
泰国临床试验注册中心TCTR20210802002。
