title: Use of deep laryngeal oxygen insufflation during laryngoscopy in children: a randomized clinical trial.
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 [Formula: see text] 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 [Formula: see text] 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 [Formula: see text] 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.
  
  
  BACKGROUND
  NCT01886807.
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Centre and Children's Health, 1935 Medical District Drive, Dallas, TX 75235, USA Outcomes Research Consortium, Cleveland, OH, USA jeffrey.steiner@utsouthwestern.edu.
authors.forename: J W
authors.initials: JW
authors.lastname: Steiner
authors.affiliation: Outcomes Research Consortium, Cleveland, OH, USA Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: D I
authors.initials: DI
authors.lastname: Sessler
authors.affiliation: Outcomes Research Consortium, Cleveland, OH, USA Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue P77, Cleveland, OH 44195, USA.
authors.forename: N
authors.initials: N
authors.lastname: Makarova
authors.affiliation: Outcomes Research Consortium, Cleveland, OH, USA Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue P77, Cleveland, OH 44195, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Mascha
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Centre and Children's Health, 1935 Medical District Drive, Dallas, TX 75235, USA.
authors.forename: P N
authors.initials: PN
authors.lastname: Olomu
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Centre and Children's Health, 1935 Medical District Drive, Dallas, TX 75235, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Zhong
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Centre and Children's Health, 1935 Medical District Drive, Dallas, TX 75235, USA.
authors.forename: C T
authors.initials: CT
authors.lastname: Setiawan
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Centre and Children's Health, 1935 Medical District Drive, Dallas, TX 75235, USA.
authors.forename: A E
authors.initials: AE
authors.lastname: Handy
authors.affiliation: Children's Medical Centre Dallas, 1935 Medical District Drive, Dallas, TX 75235, USA.
authors.forename: B N
authors.initials: BN
authors.lastname: Kravitz
authors.affiliation: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Centre and Children's Health, 1935 Medical District Drive, Dallas, TX 75235, USA Outcomes Research Consortium, Cleveland, OH, USA.
authors.forename: P
authors.initials: P
authors.lastname: Szmuk
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007327:Insufflation / Q000379:methods*; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy; D008297:Male; D010100:Oxygen / Q000097:blood*
chemical_list: D010100:Oxygen
keywords: anesthesia; apnoeic oxygenation; laryngeal oxygen insufflation; nasotracheal intubation; paediatric patients