Use of deep laryngeal oxygen insufflation during laryngoscopy in children: A randomized clinical trial

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 SpO2 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 SpO2 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 SpO2 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.