Frassanito Luciano, Grieco Domenico Luca, Vassalli Francesco, Piersanti Alessandra, Scorzoni Marco, Ciano Francesca, Zanfini Bruno Antonio, Catarci Stefano, Catena Ursula, Scambia Giovanni, Antonelli Massimo, Draisci Gaetano
From the Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart, Rome, Italy.
Department of Anesthesia, Emergency and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Anesth Analg. 2025 Jul 21. doi: 10.1213/ANE.0000000000007620.
Apneic oxygenation with high-flow nasal oxygen is a novel intraoperative respiratory support strategy for patients undergoing general anesthesia, but data about its clinical effects are scarce. We conducted a randomized trial to assess whether high-flow nasal oxygen is noninferior to mechanical ventilation through a laryngeal mask in terms of success rate of intraoperative respiratory support among patients undergoing a 30-minute general anesthesia session.
Single-center, randomized, noninferiority trial conducted in Italy between May 2022 and June 2023 and involving American Society of Anesthesiologists class I and II patients undergoing general anesthesia for operative hysteroscopy. Participants were randomized to receive laryngeal mask ventilation (volume-controlled ventilation to obtain end-tidal carbon dioxide between 35 and 45 mm Hg, inhaled oxygen fraction to achieve peripheral oxygen saturation greater than 95%) or high-flow nasal oxygen (70 L per minute, inhaled oxygen fraction of 100%) for intraoperative respiratory support. Patients received general anesthesia with propofol target-controlled infusion without neuromuscular blockade. Primary outcome was intraoperative respiratory support success rate, which was defined as peripheral oxygen saturation greater than 94% and transcutaneous carbon dioxide lower than 65 mm Hg with no need for rescue airway interventions for the entire procedure. Secondary outcomes included the rate of airway-related complications (including need for bag-mask or laryngeal mask ventilation, or tracheal intubation), postoperative respiratory symptoms, and postoperative dyspnea.
All 180 patients who were randomized completed the trial (90 patients in each group). Median [interquartile range] anesthesia duration was 25 [20-36] minutes in high-flow group and 32 minutes [27-44] in the laryngeal mask group. Intraoperative respiratory support was successful in 89 patients (99%) in both groups (absolute difference 0, unilateral 95% confidence interval, 3%, noninferiority P < .001). Incidence of postoperative respiratory symptoms was significantly lower in high-flow versus laryngeal mask group (2% vs 19%, P < .001), while airway-related complications and postoperative dyspnea were not different. Intraoperative transcutaneous carbon dioxide was significantly higher in high-flow group, with 43% of patients showing values greater than 55 mm Hg.
High-flow nasal oxygen is noninferior to laryngeal mask ventilation for intraoperative respiratory support during 30-minute general anesthesia without muscle paralysis. The risk of hypercarbia warrants careful patient selection and monitoring.
高流量鼻导管吸氧进行的无氧通气是一种用于全身麻醉患者的新型术中呼吸支持策略，但关于其临床效果的数据较少。我们进行了一项随机试验，以评估在接受30分钟全身麻醉的患者中，高流量鼻导管吸氧在术中呼吸支持成功率方面是否不劣于喉罩机械通气。
这是一项单中心、随机、非劣效性试验，于2022年5月至2023年6月在意大利进行，纳入美国麻醉医师协会I级和II级接受宫腔镜手术全身麻醉的患者。参与者被随机分配接受喉罩通气（容量控制通气，以使呼气末二氧化碳维持在35至45mmHg之间，吸入氧分数以使外周血氧饱和度大于95%）或高流量鼻导管吸氧（每分钟70L，吸入氧分数100%）用于术中呼吸支持。患者接受丙泊酚靶控输注全身麻醉，不使用神经肌肉阻滞剂。主要结局是术中呼吸支持成功率，定义为外周血氧饱和度大于94%且经皮二氧化碳低于65mmHg，整个手术过程无需抢救气道干预。次要结局包括气道相关并发症发生率（包括需要面罩或喉罩通气或气管插管）、术后呼吸症状和术后呼吸困难。
所有180例随机分组的患者均完成试验（每组90例）。高流量组的中位[四分位间距]麻醉时长为25[20 - 36]分钟，喉罩组为32分钟[27 - 44]。两组均有89例患者（99%）术中呼吸支持成功（绝对差异为0，单侧95%置信区间为3%，非劣效性P <.001）。高流量组术后呼吸症状发生率显著低于喉罩组（2%对19%，P <.001），而气道相关并发症和术后呼吸困难无差异。高流量组术中经皮二氧化碳显著更高，43%的患者数值大于55mmHg。
在30分钟无肌松的全身麻醉期间，高流量鼻导管吸氧在术中呼吸支持方面不劣于喉罩通气。高碳酸血症风险需要谨慎选择患者并进行监测。
