title: Nasal high-flow oxygen delivery in children with abnormal airways.
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.
  
  
  OBJECTIVE
  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 SpO2recorded was 96% with lowest SpO277%. 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.
  
  
  CONCLUSIONS
  Nasal high flow can be used in spontaneously breathing children with abnormal airways for maintenance of oxygenation during anesthesia for tubeless airway procedures.
authors.affiliation: 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.
authors.forename: Susan
authors.identifier: http://orcid.org/0000-0003-0286-2088
authors.initials: S
authors.lastname: Humphreys
authors.affiliation: 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.
authors.forename: Derek
authors.initials: D
authors.lastname: Rosen
authors.affiliation: 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.
authors.forename: Tessa
authors.initials: T
authors.lastname: Housden
authors.affiliation: 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.
authors.forename: Julia
authors.initials: J
authors.lastname: Taylor
authors.affiliation: 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.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schibler
mesh_terms: D000281:Administration, Intranasal; D058109:Airway Management / Q000379:methods*; D000402:Airway Obstruction; D000769:Anesthesia, Inhalation / Q000379:methods; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation; D001049:Apnea / Q000150:complications; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008738:Methyl Ethers; D010100:Oxygen / Q000008:administration & dosage*; D011446:Prospective Studies; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D010100:Oxygen
keywords: airway anomalies; airway equipment; airway technique; apnea; child; oxygen