Anesthesia, General, Apnea
Conditions
Keywords
High-flow nasal cannula, Preoxygenation, Apnea time, General anesthesia
Brief summary
This study aims to evaluate the effect of high-flow nasal oxygenation on safe apnea time for children undergoing general anesthesia, with their mouth open.
Detailed description
Oxygenation via high-flow nasal cannula is gaining popularity in various clinical settings. It is known to increase apnea time for apneic patients including children. However, high-flow nasal cannula is known to be ineffective when the patient's mouth is kept open. When trying to intubate the patient during induction of anesthesia, the patient should be apneic with administration of neuromuscular blocking agent, and the mouth should be open for introduction of laryngoscope. We designed a prospective randomized controlled study to evaluate the effect of high-flow nasal oxygenation in the aforementioned setting for trying to intubate the patient.
Interventions
DEVICEApnea with high-flow nasal cannula
Application of oxygenation with high-flow nasal cannula with a rate of 2L/kg/min
OTHERApnea
Apnea without any application of oxygenation
Sponsors
Seoul National University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
Randomized, controlled clinical trial
Eligibility
Sex/Gender
ALL
Age
No minimum to 10 Years
Healthy volunteers
No
Inclusion criteria
* Children younger than 11 years old scheduled to undergo surgery under general anesthesia, with American Society of Anesthesiologists Physical Status 1 or 2.
Exclusion criteria
* Refusal to enrollment from one or more of legal guardians of the patient * Children who are planned to use supraglottic airway device * Children with upper respiratory tract infection or pulmonary interstitial disease * Preterm babies under 40 weeks of postconceptual age * Children who are expected to have difficult airway for bag-mask ventilation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Apnea time | Elapsed time starting from discontinuation of oxygen to the time point that pulse oximetry first reaches 92% (not to exceed 520 seconds) | Time required for pulse oximetry to drop to 92% after start of apnea |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| End-tidal carbon dioxide | Procedure (From induction of anesthesia to end of anesthesia) | End-tidal carbon dioxide partial pressure during anesthesia |
| Pulse oximetry | Procedure (From induction of anesthesia to end of anesthesia) | Pulse oximetry during anesthesia |
| Non-invasive blood pressure | Procedure (From induction of anesthesia to end of anesthesia) | Non-invasive blood pressure measured from forearm or leg |
| Time to 100% | Elapsed time starting from re-start of bag-mask ventilation at the end of apnea period to the time point that pulse oximetry first reaches 100% (estimated less than 2 minutes) | Elapsed time from re-start of bag-mask ventilation to recovery of pulse oximetry of 100% after apnea |
| Minimum value of pulse oximetry | Procedure (From induction of anesthesia to end of anesthesia) | Minimum value of pulse oximetry after re-start of bag-mask ventilation after apnea |
| 1st value of end-tidal carbon dioxide | At expiration of the first manual ventilation after the end of the apnea period (less than 520 seconds after start of apnea period) | First measured value of end-tidal carbon dioxide partial pressure after re-start of bag-mask ventilation after apnea |
| Oxygen reserve index | Procedure (From induction of anesthesia to end of anesthesia) | Oxygen reserve index measured from finger or toe |
Countries
South Korea
Outcome results
None listed