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Nasal high-flow oxygen delivery in children with abnormal airways.
Paediatr Anaesth. 2017 Jun; 27(6):616-620.PA

Abstract

BACKGROUND

Transnasal Humidified Rapid-Insufflation Ventilatory Exchange has been shown to safely prolong the safe apnea time in well children post induction of anesthesia and is rapidly becoming a new standard for apneic oxygenation in adults. The same oxygenation technique is described as nasal high flow and can be used in infants and children at risk of apnea during anesthesia.

AIM

We investigated the use of nasal high flow oxygen delivery during anesthesia in children with abnormal airways requiring tubeless airway assessment or surgery.

METHODS

Data and outcomes of pediatric patients receiving nasal high flow for upper airway procedures were analyzed. Four categories were defined: (i) tubeless airway surgery, (ii) flexible bronchoscopy, (iii) expected difficult airway, and (iv) comorbidity related risk of apnea. Anesthesia was induced intravenously or with sevoflurane (4-8%) and then converted to total intravenous anesthesia aiming for spontaneous ventilation. Age appropriate nasal high flow cannulae were secured with 100% oxygen delivery at weight-related flow rates. Topicalization of the airway was achieved with lignocaine. Complication rates of desaturation requiring interruption of procedure for rescue oxygenation were recorded.

RESULTS

Twenty children were analyzed with age range of 5 days to 11 years, ASA 1-4, and weight range 3-57 kg. Fifteen were induced with sevoflurane and 100% oxygen, five received total intravenous anesthesia only. All children received Optiflow™ nasal high flow and intravenous anesthesia during their procedure. Average SpO2 recorded was 96% with lowest SpO2 77%. One required rescue oxygenation. Median length of procedure was 32 min, (range 3-61). Most common indication was tubeless airway surgery but seven children had more than one indication.

CONCLUSION

Nasal high flow can be used in spontaneously breathing children with abnormal airways for maintenance of oxygenation during anesthesia for tubeless airway procedures.

Authors+Show Affiliations

Department of Anaesthesia, Lady Cilento Children's Hospital, South Brisbane, Qld, Australia. Paediatric Critical Care Research Group, Mater Research University of Queensland, South Brisbane, Qld, Australia.Department of Anaesthesia, Lady Cilento Children's Hospital, South Brisbane, Qld, Australia. Paediatric Critical Care Research Group, Mater Research University of Queensland, South Brisbane, Qld, Australia.Department of Anaesthesia, Lady Cilento Children's Hospital, South Brisbane, Qld, Australia. Paediatric Critical Care Research Group, Mater Research University of Queensland, South Brisbane, Qld, Australia.Department of Anaesthesia, Lady Cilento Children's Hospital, South Brisbane, Qld, Australia. Paediatric Critical Care Research Group, Mater Research University of Queensland, South Brisbane, Qld, Australia.Department of Anaesthesia, Lady Cilento Children's Hospital, South Brisbane, Qld, Australia. Paediatric Critical Care Research Group, Mater Research University of Queensland, South Brisbane, Qld, Australia.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

28393433

Citation

Humphreys, Susan, et al. "Nasal High-flow Oxygen Delivery in Children With Abnormal Airways." Paediatric Anaesthesia, vol. 27, no. 6, 2017, pp. 616-620.
Humphreys S, Rosen D, Housden T, et al. Nasal high-flow oxygen delivery in children with abnormal airways. Paediatr Anaesth. 2017;27(6):616-620.
Humphreys, S., Rosen, D., Housden, T., Taylor, J., & Schibler, A. (2017). Nasal high-flow oxygen delivery in children with abnormal airways. Paediatric Anaesthesia, 27(6), 616-620. https://doi.org/10.1111/pan.13151
Humphreys S, et al. Nasal High-flow Oxygen Delivery in Children With Abnormal Airways. Paediatr Anaesth. 2017;27(6):616-620. PubMed PMID: 28393433.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nasal high-flow oxygen delivery in children with abnormal airways. AU - Humphreys,Susan, AU - Rosen,Derek, AU - Housden,Tessa, AU - Taylor,Julia, AU - Schibler,Andreas, Y1 - 2017/04/10/ PY - 2017/03/08/accepted PY - 2017/4/11/pubmed PY - 2018/3/9/medline PY - 2017/4/11/entrez KW - airway anomalies KW - airway equipment KW - airway technique KW - apnea KW - child KW - oxygen SP - 616 EP - 620 JF - Paediatric anaesthesia JO - Paediatr Anaesth VL - 27 IS - 6 N2 - BACKGROUND: Transnasal Humidified Rapid-Insufflation Ventilatory Exchange has been shown to safely prolong the safe apnea time in well children post induction of anesthesia and is rapidly becoming a new standard for apneic oxygenation in adults. The same oxygenation technique is described as nasal high flow and can be used in infants and children at risk of apnea during anesthesia. AIM: We investigated the use of nasal high flow oxygen delivery during anesthesia in children with abnormal airways requiring tubeless airway assessment or surgery. METHODS: Data and outcomes of pediatric patients receiving nasal high flow for upper airway procedures were analyzed. Four categories were defined: (i) tubeless airway surgery, (ii) flexible bronchoscopy, (iii) expected difficult airway, and (iv) comorbidity related risk of apnea. Anesthesia was induced intravenously or with sevoflurane (4-8%) and then converted to total intravenous anesthesia aiming for spontaneous ventilation. Age appropriate nasal high flow cannulae were secured with 100% oxygen delivery at weight-related flow rates. Topicalization of the airway was achieved with lignocaine. Complication rates of desaturation requiring interruption of procedure for rescue oxygenation were recorded. RESULTS: Twenty children were analyzed with age range of 5 days to 11 years, ASA 1-4, and weight range 3-57 kg. Fifteen were induced with sevoflurane and 100% oxygen, five received total intravenous anesthesia only. All children received Optiflow™ nasal high flow and intravenous anesthesia during their procedure. Average SpO2 recorded was 96% with lowest SpO2 77%. One required rescue oxygenation. Median length of procedure was 32 min, (range 3-61). Most common indication was tubeless airway surgery but seven children had more than one indication. CONCLUSION: Nasal high flow can be used in spontaneously breathing children with abnormal airways for maintenance of oxygenation during anesthesia for tubeless airway procedures. SN - 1460-9592 UR - https://www.unboundmedicine.com/medline/citation/28393433/Nasal_high_flow_oxygen_delivery_in_children_with_abnormal_airways_ L2 - https://doi.org/10.1111/pan.13151 DB - PRIME DP - Unbound Medicine ER -