Department of Anesthesiology and Pain medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Medicine (Baltimore). 2022 Jul 8;101(27):e29520. doi: 10.1097/MD.0000000000029520.
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.
高流量鼻氧在麻醉期间用于呼吸暂停和自主呼吸的成人患者中越来越受欢迎。本前瞻性观察研究评估了高流量鼻氧在维持动态气道阻塞的自主呼吸儿科患者氧合和通气方面的作用，这些患者正在接受无管气道手术。通过适当年龄的高流量鼻导管以 2 L·kg-1·min-1 的流速提供氧气。在保留自主呼吸的同时使用丙泊酚和瑞芬太尼维持麻醉。我们旨在确定需要抢救通气的发生率和危险因素。当脉搏血氧饱和度<90%或经皮二氧化碳分压>80 mmHg 时，使用面罩进行抢救通气。共有 27 例患者纳入最终分析。脉搏血氧饱和度和经皮二氧化碳分压中位数（四分位距）分别为 100%（99%-100%）和 58.4 mmHg（51.4-70.3 mmHg）。共有 9 例（33.3%）患者在麻醉期间需要抢救通气。其中，7 例（25.9%）患者发生氧饱和度下降（<90%），2 例（7.4%）患者发生高碳酸血症。需要抢救通气的患者明显更年轻（8.2 与 28.8 个月，P =.02），麻醉时间更长（55.7 与 41.0 分钟，P =.04）。总之，高流量鼻氧是维持气道手术患儿氧合的替代技术。然而，年龄较小和麻醉时间较长是导致这些患者需要抢救通气的显著危险因素。需要进一步进行大样本量的研究，以将这些技术应用于临床。
