The use of apneic oxygenation during prolonged intubation in pediatric patients: a randomized clinical trial

Study ID
STU 052012-100

Cancer Related
No

Healthy Volunteers
No

Study Sites

  • Children's Medical Center-Dallas

Contact
Roxana Ploski
214-456-8559
roxana.ploski@utsouthwestern.edu

Principal Investigator
Jeffrey Steiner

Summary

Patient demographics (age, height and weight) will be collected for 546 consecutive patients presenting for dental restoration under Ga. oxygen sensors will be placed on the subject prior to anesthesia induction. The oxygen saturation will be recorded continuously. Recording will proceed for 1 minute, then the subject will receive 100% oxygen via face mask for 3-4 minutes. The induction of anesthesia will be standardized for all patients. all patients will undergo an inhalational induction with 100% o2 and sevoflurane administered by face mask. after inserting an iV line, 0.6 mg/kg of rocuronium will be administered. intravenous 1-2 mg/kg of propofol could be added at the discretion of the anesthesiologist. The patients will be mask ventilated then be with a mixture of n2o/o2 or air/o2 to achieve an Fio2 of 0.3 for 3 minutes after the administration of rocuronium. Patients will be intubated according to one of three groups for the purpose of airway management: 1) direct laryngoscopy for nasotracheal intubation without oxygen insufflation (DL group); 2) direct laryngoscopy for nasotracheal intubation with oxygen insufflation (DL-o2 Group) 3) nasotracheal intubation using the Truview PCD video laryngoscope (VL Group). General anesthesia x airway management sequence:
* Mask induction with spontaneous ventilation
oPre-oxygenation recording of oxygen saturation
o3-4 minutes recording at 100% oxygen and sevofluorane via face mask
* intravenous cannula placement
* intravenous anesthesia administered (Rocuronium and any other anesthestic drugs at the discretion of attending anesthesiologist)
* Mask ventilation with air/o2 or n2o/o2 at an Fio2 of 0.3 for 3 minutes after iV medications
* Laryngoscopy to view the oropharnyxx one of three randomized groups
* Red rubber tube insertion into the naris
* Visualization of the red rubber tube tip in the oropharynx
* Retrieval of the red rubber tube with the eTT with the Magill forceps
* insertion of the eTT into the glottis (through the vocal cords)
* Removal of the laryngoscope blade
* Connection of the eTT to the anesthesia circuit
* Bag ventilation
The study will be stopped when:
* the patient will be intubated and a Co2 trace is obtained on the capnography or
* if the patient desaturates to 90%
* or if the patient shows signs of cardiac instability (ectopic beats, arrhythmia or hypotension)

Participant Eligibility

Inclusion Criteria

* Children scheduled for dental restoration under general nasotracheal anesthesia

* Patient age 1-17 years

* American Society of Anesthesiology physical status I, II, and III.