None listed
Conditions
Brief summary
Induction of anaesthesia and management of the airway is designed to prevent a child from suffering a lack of oxygen during the phase from consciousness to deep anaesthesia for a surgical procedure. Current practice provides a very high standard of induction of anaesthesia with a very low number of complications. However if anaesthesia needs to be achieved in emergency settings of in the presence of a complicated airway, the rate of complication rapidly increases. Particularly in emergency settings experienced operators are often not present. In these circumstances newer methods to reduce the risk of complications is desirable. This study investigates under very controlled circumstances in a tertiary children’s hospital a new concept to prolong the time to secure and improve airway management. The results and findings will then be tested in emergency settings in a follow up study.
Interventions
High Flow Nasal Cannula therapy (at 2mls/kg/min for children 0-15kg, 35L/min for children 15-30kg, 40L/min for 30-50kg, 50L/min for children greater than 50kg in 100%Fi02) used for a maximum 7 min and 9 sec dependant on age (see graph below) after inhalation induction of anaesthesia and bag/mask ventilation for two minutes with 100% Fi02 with flow rate adequate to provide good minute volume ventilation (normally 6L) to maintain SpO2 100% aiming for expired oxygen greater than 90% and End Tidal C
High Flow Nasal Cannula therapy (at 2mls/kg/min for children 0-15kg, 35L/min for children 15-30kg, 40L/min for 30-50kg, 50L/min for children greater than 50kg in 100%Fi02) used for a maximum 7 min and 9 sec dependant on age (see graph below) after inhalation induction of anaesthesia and bag/mask ventilation for two minutes with 100% Fi02 with flow rate adequate to provide good minute volume ventilation (normally 6L) to maintain SpO2 100% aiming for expired oxygen greater than 90% and End Tidal Carbon Dioxide 35-45mmHg; and prior to intubation in children with normal airways. Referenced apnoeic times maximal apnoeic time for HFNC Age 1 0-6 mths 96.5 secs 193 secs (3 min 13 secs) 2 6-24 mths 118.5 secs 237 secs (3 min 57 secs) 3 2 – 5 yrs 160.4 secs 321 secs (5 min 21 secs) 4 6 – 10 yrs 214.9 secs 429 secs (7 min 9 secs) * Order of events: 1. Induction of anaestheisa, 2. Bag mask ventilation for 2 minutes, 3. Bag mask ventilation discontinued, 4. High flow for a maximun of 7 min and 9 sec in 100% Fi02 . 5. Bag mask ventilation recommenced. irrespectively of whether the Sp02 have changed or not. 6. Laryngoscopy is carried out to ascertain Cormack and Lehane classification and airway is secured as appropriate for procedure.
Sponsors
Lady Cilento Children's Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
0 to 18 Years
Healthy volunteers
No
Inclusion criteria
ASA 1 or 2 Non obese Normal airway assessment Children presenting for elective medical imaging or surgical procedures Suitable for inhalation induction
Exclusion criteria
Obesity Abnormal airway assessment Oxygen dependency Lung disease Congenital Heart Disease Gastro Oesophageal Reflux Children requiring premedication of anxiolytics or sedatives Propofol allergy
Outcome results
None listed