Use of deep laryngeal oxygen insufflation during laryngoscopy in children: A randomized clinical trial

J. W. Steiner, D. I. Sessler, N. Makarova, E. J. Mascha, P. N. Olomu, J. W. Zhong, C. T. Setiawan, A. E. Handy, B. N. Kravitz, P. Szmuk

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background Brief periods of haemoglobin oxygen desaturation are common in children during induction of general anaesthesia. We tested the hypothesis that oxygen insufflation during intubation slows desaturation. Methods Patients 1-17 yr old undergoing nasotracheal intubation were enrolled and randomly assigned to one of three groups: standard direct laryngoscopy (DL); laryngoscopy with Truview PCD videolaryngoscope (VLO2); or laryngoscopy with an oxygen cannula attached to the side of a standard laryngoscope (DLO2). The co-primary outcomes were time to 1% reduction in SpO2 from baseline, and the slope of overall desaturation vs time. All three groups were compared against each other. Results Data from 457 patients were available for the final analysis: 159 (35%) DL; 145 (32%) DLO2; and 153 (33%) VLO2. Both VLO2 and DLO2 were superior to DL in both time to a 1% reduction in SpO2 from baseline and the overall rate of desaturation (all P<0.001). The 25th percentile (95% confidence interval) of time to a 1% saturation decrease was 30 (24, 39) s for DL, 67 (35, 149) s for DLO2 and 75 (37, 122) s for VLO2. Mean desaturation slope was 0.13 (0.11, 0.15)% s-1 for DL, 0.04 (0.02, 0.06)% s-1 for DLO2 and 0.03 (0.004, 0.05)% s-1 for VLO2. We did not find a correlation between decrease in SpO2 percentage and BMI or age. Conclusions Laryngeal oxygen insufflation increases the time to 1% desaturation and reduces the overall rate of desaturation during laryngoscopy in children.

Original languageEnglish (US)
Pages (from-to)350-357
Number of pages8
JournalBritish Journal of Anaesthesia
Volume117
Issue number3
DOIs
StatePublished - Sep 1 2016

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Insufflation
Laryngoscopy
Randomized Controlled Trials
Oxygen
Intubation
Laryngoscopes
General Anesthesia
Hemoglobins
Confidence Intervals

Keywords

  • anesthesia
  • apnoeic oxygenation
  • laryngeal oxygen insufflation
  • nasotracheal intubation
  • paediatric patients

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Use of deep laryngeal oxygen insufflation during laryngoscopy in children : A randomized clinical trial. / Steiner, J. W.; Sessler, D. I.; Makarova, N.; Mascha, E. J.; Olomu, P. N.; Zhong, J. W.; Setiawan, C. T.; Handy, A. E.; Kravitz, B. N.; Szmuk, P.

In: British Journal of Anaesthesia, Vol. 117, No. 3, 01.09.2016, p. 350-357.

Research output: Contribution to journalArticle

Steiner, J. W. ; Sessler, D. I. ; Makarova, N. ; Mascha, E. J. ; Olomu, P. N. ; Zhong, J. W. ; Setiawan, C. T. ; Handy, A. E. ; Kravitz, B. N. ; Szmuk, P. / Use of deep laryngeal oxygen insufflation during laryngoscopy in children : A randomized clinical trial. In: British Journal of Anaesthesia. 2016 ; Vol. 117, No. 3. pp. 350-357.
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abstract = "Background Brief periods of haemoglobin oxygen desaturation are common in children during induction of general anaesthesia. We tested the hypothesis that oxygen insufflation during intubation slows desaturation. Methods Patients 1-17 yr old undergoing nasotracheal intubation were enrolled and randomly assigned to one of three groups: standard direct laryngoscopy (DL); laryngoscopy with Truview PCD videolaryngoscope (VLO2); or laryngoscopy with an oxygen cannula attached to the side of a standard laryngoscope (DLO2). The co-primary outcomes were time to 1{\%} reduction in SpO2 from baseline, and the slope of overall desaturation vs time. All three groups were compared against each other. Results Data from 457 patients were available for the final analysis: 159 (35{\%}) DL; 145 (32{\%}) DLO2; and 153 (33{\%}) VLO2. Both VLO2 and DLO2 were superior to DL in both time to a 1{\%} reduction in SpO2 from baseline and the overall rate of desaturation (all P<0.001). The 25th percentile (95{\%} confidence interval) of time to a 1{\%} saturation decrease was 30 (24, 39) s for DL, 67 (35, 149) s for DLO2 and 75 (37, 122) s for VLO2. Mean desaturation slope was 0.13 (0.11, 0.15){\%} s-1 for DL, 0.04 (0.02, 0.06){\%} s-1 for DLO2 and 0.03 (0.004, 0.05){\%} s-1 for VLO2. We did not find a correlation between decrease in SpO2 percentage and BMI or age. Conclusions Laryngeal oxygen insufflation increases the time to 1{\%} desaturation and reduces the overall rate of desaturation during laryngoscopy in children.",
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T2 - A randomized clinical trial

AU - Steiner, J. W.

AU - Sessler, D. I.

AU - Makarova, N.

AU - Mascha, E. J.

AU - Olomu, P. N.

AU - Zhong, J. W.

AU - Setiawan, C. T.

AU - Handy, A. E.

AU - Kravitz, B. N.

AU - Szmuk, P.

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AB - Background Brief periods of haemoglobin oxygen desaturation are common in children during induction of general anaesthesia. We tested the hypothesis that oxygen insufflation during intubation slows desaturation. Methods Patients 1-17 yr old undergoing nasotracheal intubation were enrolled and randomly assigned to one of three groups: standard direct laryngoscopy (DL); laryngoscopy with Truview PCD videolaryngoscope (VLO2); or laryngoscopy with an oxygen cannula attached to the side of a standard laryngoscope (DLO2). The co-primary outcomes were time to 1% reduction in SpO2 from baseline, and the slope of overall desaturation vs time. All three groups were compared against each other. Results Data from 457 patients were available for the final analysis: 159 (35%) DL; 145 (32%) DLO2; and 153 (33%) VLO2. Both VLO2 and DLO2 were superior to DL in both time to a 1% reduction in SpO2 from baseline and the overall rate of desaturation (all P<0.001). The 25th percentile (95% confidence interval) of time to a 1% saturation decrease was 30 (24, 39) s for DL, 67 (35, 149) s for DLO2 and 75 (37, 122) s for VLO2. Mean desaturation slope was 0.13 (0.11, 0.15)% s-1 for DL, 0.04 (0.02, 0.06)% s-1 for DLO2 and 0.03 (0.004, 0.05)% s-1 for VLO2. We did not find a correlation between decrease in SpO2 percentage and BMI or age. Conclusions Laryngeal oxygen insufflation increases the time to 1% desaturation and reduces the overall rate of desaturation during laryngoscopy in children.

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