Effectiveness of Apneic Oxygenation During Induction of General Anesthesia in Children Undergoing Adenotonsillectomy: A Prospective Randomized Controlled Study.

BACKGROUND

Children undergoing adenotonsillectomy often have partial airway obstruction due to hypertrophic tonsils and adenoids, increasing their risk of oxygen desaturation during anesthesia induction.

OBJECTIVES

This study aimed to evaluate whether apneic oxygenation via nasal cannula prevents oxygen desaturation during tracheal intubation in children aged 3 - 10 years undergoing adenotonsillectomy while assessing its effects on intubation conditions and hemodynamic stability.

METHODS

In this prospective, single-blinded, randomized controlled trial, 140 children scheduled for adenotonsillectomy were allocated to either standard intubation (group A, n = 70) or apneic oxygenation (group B, n = 70; 0.2 L/kg/min via nasal cannula). The primary outcome was the lowest peripheral oxygen saturation (SpO₂) during intubation.

RESULTS

Peripheral SpO₂ was significantly lower during intubation in group A (97.40 ± 2.96) than in group B (99.91 ± 0.28) (P < 0.001). Group B also maintained significantly higher SpO₂ immediately after intubation (99.91 ± 0.28%) than group A (97.77 ± 2.24%; P < 0.001). No episodes of desaturation occurred in group B during the procedure (P < 0.001). In group A, 21.43% of patients desaturated to ≤ 95% (P < 0.001). Severe desaturation (SpO₂ < 92%) occurred in 7.14% of controls but was absent in group B (P = 0.023). Intubation time, intubation attempts, and bradycardia rates were comparable between groups (P > 0.05).

CONCLUSIONS

Apneic oxygenation during intubation in children undergoing adenotonsillectomy effectively prevented desaturation without compromising safety or procedural efficiency.