title: Apneic preoxygenation without nasal prongs: the "Hungarian Air Ambulance method".
abstract: The Hungarian Air Ambulance has recently adopted oxygen supplementation during laryngoscopy, also known as apneic preoxygenation, to prevent desaturation during rapid sequence intubation. Despite its simplicity the nasal cannula method has some limitations relevant to our practice. First, the cannula can dislodge if the head is manipulated during preparation or intubation, especially if nasopharyngeal airways are chosen to maximise preoxygenation. Second, the method is incompatible with continuous nasal suctioning required in severe maxillofacial trauma. Third, if only one oxygen source and one competent assistant is available, a situation common during prehospital missions, the extra tube swap needed for continuous oxygen supplementation makes the procedure more complex and prone to error. We report a new method that provides comparable oxygen supplementation to the nasal cannula method, but at the same time eliminates the problems mentioned above and is easier and quicker to perform. It requires the intubator to cut and insert the tubing of the non-rebreather mask into the nasopharyngeal airway, thus providing direct pharyngeal insufflation. The method is applicable to every patient who has at least one nasopharyngeal airway inserted at the time of laryngoscopy and it only requires a pair of scissors.
authors.affiliation: Hungarian Air Ambulance Nonprofit Ltd., Legimentok utca 8, Budaors, H-2040, Hungary. drerossattila@gmail.com.|Department of Anaesthesiology and Intensive Care, Medical Centre, Hungarian Defence Forces, Robert Karoly korut 44, Budapest, H-1134, Hungary. drerossattila@gmail.com.
authors.forename: Attila
authors.initials: A
authors.lastname: Eross
authors.affiliation: Hungarian Air Ambulance Nonprofit Ltd., Legimentok utca 8, Budaors, H-2040, Hungary. laszlo.hetzman@airambulance.hu.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Hetzman
authors.affiliation: Hungarian Air Ambulance Nonprofit Ltd., Legimentok utca 8, Budaors, H-2040, Hungary. andraspetroczy@gmail.com.|Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Kutvolgyi ut 4, Budapest, H-1125, Hungary. andraspetroczy@gmail.com.
authors.forename: Andras
authors.initials: A
authors.lastname: Petroczy
authors.affiliation: Hungarian Air Ambulance Nonprofit Ltd., Legimentok utca 8, Budaors, H-2040, Hungary. laszlo.gorove@airambulance.hu.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Gorove
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances; D002648:Child; D005260:Female; D006801:Humans; D006814:Hungary; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D010100:Oxygen