Uzun Davut Deniz, Hezel Felix, Mohr Stefan, Weigand Markus A, Schmitt Felix C F
Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg University, Heidelberg, Germany.
BMC Anesthesiol. 2025 Mar 8;25(1):116. doi: 10.1186/s12871-025-02995-2.
Children, especially neonates and infants, are at particularly high risk of hypoxemia during induction of anesthesia. The addition of nasal apnoeic oxygenation (ApOx) during tracheal intubation should prolong safe apnoea time without desaturation and reduce the risk of hypoxemia. Despite the recommendations in the relevant European guidelines, their implementation in pediatric anesthesia in Germany is not yet known.
A survey was conducted in July and October 2024 via email to all registered members of the scientific working group on airway management, the scientific working group on pediatric anesthesia of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and hospitals of all levels in Germany. Participants were asked about their personal and institutional background and the use of ApOx in pediatric anesthesia in their institution.
Of the eight hundred participants invited, 304 anesthetists completed the survey (response rate 38%). In addition, 36 of 109 invited anesthetists from the scientific working group on pediatric anesthesia were interviewed as a separate expert group. 201 (66.1%) of the anesthetists surveyed in the general group stated that they worked regular in pediatric anesthesia (pediatric anesthesia expert group: 94.4%). 64.2% of the general respondents considered pediatric patients to be at an increased risk of reduced apnoea time. 46.7% of the general participants are of the opinion that pediatric patients should generally not receive ApOx during induction of anesthesia. If ApOx is performed, then most likely with a standard nasal cannula. ApOx was generally used in infants with an oxygen flow rate of ≤ 2 l/min or 0.2 l/kg bodyweight/min. A relevant proportion of anesthetists were unaware that current European guidelines recommend ApOx for neonates and infants (general participants: 62.5%, pediatric anesthesia expert group: 39%).
Despite the recommendations in the guidelines, the use of ApOx does not appear to be standard practice at present. Furthermore, the surveyed physicians exhibited considerable uncertainty regarding ApOx. It is imperative that further improvements are made in the dissemination of the current guidelines with a view to enhancing patient safety during pediatric anesthesia.
儿童，尤其是新生儿和婴儿，在麻醉诱导期间发生低氧血症的风险特别高。在气管插管期间增加经鼻无呼吸氧合（ApOx）应能延长安全无呼吸时间而不出现氧饱和度下降，并降低低氧血症风险。尽管欧洲相关指南中有建议，但在德国儿科麻醉中的实施情况尚不清楚。
于2024年7月和10月通过电子邮件对气道管理科学工作组、德国麻醉与重症医学学会（DGAI）儿科麻醉科学工作组的所有注册成员以及德国各级医院进行了一项调查。参与者被问及他们的个人和机构背景以及他们所在机构在儿科麻醉中使用ApOx的情况。
在邀请的800名参与者中，304名麻醉医生完成了调查（回复率38%）。此外，来自儿科麻醉科学工作组的109名受邀麻醉医生中的36名作为单独的专家组接受了访谈。普通组中接受调查的麻醉医生中有201名（66.1%）表示他们经常从事儿科麻醉工作（儿科麻醉专家组：94.4%）。64.2%的普通受访者认为儿科患者无呼吸时间缩短的风险增加。46.7%的普通参与者认为儿科患者在麻醉诱导期间一般不应接受ApOx。如果进行ApOx，最有可能使用标准鼻导管。ApOx一般用于氧流量≤2升/分钟或0.2升/千克体重/分钟的婴儿。相当一部分麻醉医生不知道当前欧洲指南推荐对新生儿和婴儿使用ApOx（普通参与者：62.5%，儿科麻醉专家组：39%）。
尽管指南中有建议，但目前ApOx的使用似乎并非标准做法。此外，接受调查的医生对ApOx表现出相当大的不确定性。迫切需要进一步改进当前指南的传播，以提高儿科麻醉期间的患者安全性。
