Apneic oxygenation in pediatric anesthesia.

Maren Kleine-Brueggeney, Mareike Grosshauser, Robert Greif

Current opinion in anaesthesiology 2022 Jun 01

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Apneic oxygenation is increasingly used in pediatric anesthesia. Its benefit for specific applications depends on the effect of apneic oxygenation on safe apnea time and carbon dioxide (CO2) elimination, on differences between low and high flow oxygen delivery, and on possible adverse effects. The present review summarizes current evidence on these pathophysiological aspects of apneic oxygenation as well as its applications in pediatric anesthesia. Apneic oxygenation with both low flow and high flow nasal oxygen increases the safe apnea time, but does not lead to increased CO2 elimination. Airway pressures and adverse effects like atelectasis formation, oxidative stress and aerosol generation under apneic oxygenation are not well studied in pediatric anesthesia. Data from adults suggest no important effect on airway pressures when the mouth is open, and no significant formation of atelectasis, oxidative stress or aerosol generation with high flow nasal oxygen. Apneic oxygenation in pediatric anesthesia is mainly used during standard and difficult airway management. It is sometimes used for airway interventions, but CO2 accumulation remains a major limiting factor in this setting. Reports highlight the use of high flow nasal oxygen in spontaneously breathing rather than in apneic children for airway interventions. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Citation

Maren Kleine-Brueggeney, Mareike Grosshauser, Robert Greif. Apneic oxygenation in pediatric anesthesia. Current opinion in anaesthesiology. 2022 Jun 01;35(3):361-366