An objective of this study was to investigate the effectiveness of apnoeic oxygenation during airway management in children. Airway management is a core clinical skill in anesthesia. Pre-oxygenation before induction of anesthesia is a standard practice to prevent desaturation. Apnoeic oxygenation in adults is efficient and prolongs the time to desaturation. Anaesthetic agents and muscle relaxants used in general anesthesia inhibit spontaneous respiration, resulting in apnoea. 

During periods of apnoea, it is necessary to manage patients’ ventilation and oxygenation. Providing sufficient oxygen before attempting to secure the airway, known as pre-oxygenation, is a standard oxygenation method that sustains adequate oxygen saturation during airway management by denitrogenating the lungs, providing an oxygen reservoir which facilitates extended intubation.

Usually, the pre-oxygenation technique is the key factor that assures adequate oxygenation during airway management. However, providing continuous oxygenation during airway management, called apnoeic oxygenation, provides additional time for maintaining safe oxygen saturation. 

Apnoeic oxygenation is thought to be useful and worth considering in anesthesiology. After pre-oxygenation, anesthetized patients can still receive oxygen during intubation without hindering the laryngeal view. The evidence has recommended that apnoeic oxygenation is considered in addition to pre-oxygenation, which contributes to changing airway management practice.

The aim of this pilot study was to investigate the effectiveness of apnoeic oxygenation via a nasal cannula in a pediatric population. The effectiveness of apnoeic oxygenation was evaluated by measuring two primary outcomes: duration of safe apnoea and lowest SpO2 observed during airway management.

In this study, the definition of the duration of safe apnoea was based on time to the first event: either time for SpO2 to drop to 92% or time to successfully secure the airways without allowing desaturation. 

Further research into the effectiveness of apnoeic oxygenation on children should address the limitations of this pilot study. A large-scale randomized controlled trial would provide better findings and more conclusive results.

Previous studies on healthy adults and obese patients have measured the duration of safe apnoea and the lowest oxygen saturation observed by allowing desaturation. This pilot randomized controlled trial attempted to investigate the effectiveness of apnoeic oxygenation, by 3 l/min nasal cannula, in children undergoing general anesthesia.

The results showed no significant difference between the two groups on the duration of safe apnoea, which contradicts previous studies on healthy adults and obese patients due to methodological differences. However, the lowest oxygen saturation observed was statistically different between the two groups.

The results regarding the lowest oxygen saturation observed in this study are consistent with previous studies on adults, suggesting that apnoeic oxygenation is an effective method of oxygenation to maintain high oxygen saturation during airway management. A large-scale randomized controlled trial would confirm the present findings, as the low sample size and duration of this study limit its rigor.