Apnoeic Oxygenation by Nasal Cannula During Airway Management in Children Undergoing General Anaesthesia.

Study Overview
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Brief Summary
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Airway management is a core clinical skill in anaesthesia. Pre-oxygenation prior to induction of anaesthesia is standard practice to prevent desaturation. Apnoeic oxygenation in adults is effective and prolongs the time to desaturation. The effectiveness of apnoeic oxygenation in the adult is well document, however evidence in the paediatric is lacking. Therefore, the aim of this study was to investigate the effectiveness of apnoeic oxygenation during airway management in children. This was a pilot randomised controlled trial. Patients were randomised to either receive apnoeic oxygenation or standard care during the induction of anaesthesia. The primary outcome was the duration of safe apnoea, defined as a composite of the time to first event, either time for SpO2 to drop to 92% or time to successfully secure the airway, and the lowest SpO2 observed during airway management. Secondary outcomes were number of patients whose SpO2 dropped below 95% and number of patients whose SpO2 dropped below 92%.

Official Title
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Apnoeic Oxygenation by Nasal Cannula During Airway Management in Children Undergoing General Anaesthesia: A Pilot Randomised Controlled Trial

Conditions
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Apnoeic Oxygenation

Intervention / Treatment
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* Device: Apnoeic oxygenation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients were included who were scheduled for elective surgery under general anaesthesia. Age: one eight years old. ASA I and II only. Patients with normal cardiorespiratory function. Exclusion Criteria: Children undergoing dental surgeries in which nasal intubation is needed. Patients who suffered from quick drops in oxygen saturation more rapidly than healthy children due to different reasons such as: respiratory and pulmonary diseases, active or recent upper respiratory tract infection, syndromes with cardiopulmonary pathologies, cardiac anomalies, anaemia, depressed respiratory effort, ventilation/perfusion imbalance, Obstructive Sleep Apnoea (OSA), and airway obstruction. Patients reported with nasal obstruction. Patients with grades of laryngoscopic view (Cormack Lahane) greater than II, which indicates upper airway obstruction.

Ages Eligible for Study
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Minimum Age: 1 Year
Maximum Age: 8 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Apnoeic oxygenation group<br>Standard airway management + 3 L/min of oxygen by nasal cannula | Device: Apnoeic oxygenation<br>* 3 L/min of oxygen by nasal cannula during as apnoeic oxygenation during airway management.<br>|
| No Intervention: Standard care group<br>Standard airway management | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to first event | Time to first event: either time for SpO2 to fall to 92% or time to successfully secure the airway as usual practice without allowing desaturation | Estimated: 10 seconds to 3 minutes | 
| The lowest SpO2 observed during airway management | The lowest SpO2 observed during airway management | Estimated: 10 seconds to 3 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of patients whose SpO2 dropped below 95% | Number of patients whose SpO2 dropped below 95% | Estimated: 10 seconds to 3 minutes | 
| Number of patients whose SpO2 dropped below 92% | Number of patients whose SpO2 dropped below 92% | Estimated: 10 seconds to 3 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Apnoeic oxygenation, Airway management, Oxygen insufflation, Paediatric general anaesthesia