Low-flow Oxygen Delivery Using a Nasal Cannula for Apnoeic Oxygenation in Children Undergoing Elective Surgery Under General Anaesthesia: A Randomised Controlled Trial

Overview

Journal Eur J Anaesthesiol Intensive Care

Date 2025 Feb 7

PMID 39916811

Authors

Sohini Ray

Anju R Bhalotra

Mona Arya

Kavita R Sharma

Affiliations

Soon will be listed here.

Abstract

Background: Children have a smaller functional residual capacity and higher rate of oxygen consumption making them prone to develop hypoxaemia during a period of apnoea. The effectiveness of apnoeic oxygenation in preventing oxygen desaturation during laryngoscopy and intubation in small children has not been well studied.

Objective: To assess the effectiveness of apnoeic oxygenation using a nasal cannula in preventing oxygen desaturation during laryngoscopy and intubation in children.

Design: Prospective randomised double-blind controlled trial.

Setting: Tertiary care teaching hospital between January 2020 and September 2021.

Patients: One hundred and twenty children of 1 to 6 years age undergoing elective surgery requiring general anaesthesia with endotracheal intubation.

Intervention: Patients were randomly allocated to receive 3 l min oxygen by nasal cannula (apnoeic oxygenation group) or no oxygen (control group). Laryngoscopy and intubation was undertaken by a trainee anaesthesiologist.

Main Outcome Measures: The primary outcome was the lowest value of peripheral oxygen saturation (SpO) during laryngoscopy and intubation. Secondary outcomes were the number of children whose SpO dropped to 95%, from 92% to < 95%, and below 92% and the incidence of bradycardia.

Results: The mean ± SD of lowest SpO values was 99.95 ± 0.29% in the apnoeic oxygenation group and 98.37 ± 4.60% in the control group ( 0.009). No fall of SpO occurred in any patient in the apnoeic oxygenation group in spite of a longer apnoea time ( = 0.012). In the control group, 43 patients had no fall in SpO ( < 0.001), in 12 patients there was a fall in SpO to 95% ( 0.004), in one patient SpO fell to 92 to <95% ( 0.315) and in four patients SpO fell below 92% ( 0.038). There was no incidence of bradycardia.

Conclusion: Apnoeic oxygenation using a nasal cannula was effective in preventing oxygen desaturation during laryngoscopy and intubation in children as compared with those who did not receive apnoeic oxygenation.

Trial Registration: Clinical Trials Registry of India: CTRI/2020/01/022724 (www.ctri.nic.in).

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