A Nasal High-Flow System Prevents Upper Airway Obstruction and Hypoxia in Pediatric Dental Patients Under Intravenous Sedation

Sago, Teppei; Watanabe, Kôji; Kawabata, Kazune; Shiiba, Shunji; Maki, Kenshi; Watanabe, Seiji

doi:10.1016/j.joms.2020.10.018

Cited by 10 publications

(29 citation statements)

References 30 publications

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“…In obese patients (BMI>25), the partial pressure of arterial carbon dioxide (PaCO 2 ) was 50.1 ± 6.0 mmHg (95 % CI 47.2–53.1) in the control group and 47.6 ± 4.8 mmHg (95 % CI 45.2–50.0) in the NHF (40 % O 2 , 40 L/min) group (P = 0.018) [15] . In pediatric dental patients, the lowest peripheral capillary oxygen saturation values during treatment were higher in the NHF group (2 kg/L/min up to a maximum of 30 L/min) compared to the control group (P < 0.05) [17] . In addition, 10 patients in the control group compared to 3 patients in the NHF group required jaw lifting to relieve upper airway obstruction and facilitate spontaneous breathing (P < 0.05).…”

Section: Resultsmentioning

confidence: 76%

“…Three of these articles were related to English NHF RCTs during dental procedure with sedation. Further screening of the full texts identified three RCTs that met our inclusion criteria [15] , [17] , [18] . The data extracted from these RCTs are detailed in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…In that study, the PaCO 2 was measured once, at the 10 min time point after the beginning of the dental procedure in obese patients with intellectual disabilities. The findings from two RCTs [17] , [18] suggested that NHF therapy can prevent upper airway obstruction and improve the respiratory condition of pediatric dental patients under sedation. The use of NHF in pediatric dental patients significantly improved the lowest peripheral capillary oxygen saturation values during treatment, reduced the need for intervention to relieve upper airway obstruction, and facilitated spontaneous breathing.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The clinical advantage of nasal high-flow in respiratory management during procedural sedation: A scoping review on the application of nasal high-flow during dental procedures with sedation

Kurata

Sanuki

Higuchi

et al. 2022

Japanese Dental Science Review

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Section: Resultsmentioning

confidence: 76%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The clinical advantage of nasal high-flow in respiratory management during procedural sedation: A scoping review on the application of nasal high-flow during dental procedures with sedation

Kurata

Sanuki

Higuchi

et al. 2022

Japanese Dental Science Review

Self Cite

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“…Duan et al [18] reported that the use of HFNO for deep sedation in the congenital cardiac catheter lab reduced the incidence of desaturations and the need for assisted ventilation compared to simple oxygen mask. Similarly, Sago et al [38] reported that HFNO during dental surgery reduced desaturations and upper airway obstruction in children.…”

Section: Applications Of Hfno Beyond Apneic Oxygenationmentioning

confidence: 89%

Apneic oxygenation in pediatric anesthesia

Kleine‐Brueggeney

Grosshauser

Greif

2022

Current Opinion in Anaesthesiology

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Purpose of reviewApneic oxygenation is increasingly used in pediatric anesthesia. Its benefit for specific applications depends on the effect of apneic oxygenation on safe apnea time and carbon dioxide (CO2) elimination, on differences between low and high flow oxygen delivery, and on possible adverse effects. The present review summarizes current evidence on these pathophysiological aspects of apneic oxygenation as well as its applications in pediatric anesthesia.Recent findingsApneic oxygenation with both low flow and high flow nasal oxygen increases the safe apnea time, but does not lead to increased CO2 elimination. Airway pressures and adverse effects like atelectasis formation, oxidative stress and aerosol generation under apneic oxygenation are not well studied in pediatric anesthesia. Data from adults suggest no important effect on airway pressures when the mouth is open, and no significant formation of atelectasis, oxidative stress or aerosol generation with high flow nasal oxygen.SummaryApneic oxygenation in pediatric anesthesia is mainly used during standard and difficult airway management. It is sometimes used for airway interventions, but CO2 accumulation remains a major limiting factor in this setting. Reports highlight the use of high flow nasal oxygen in spontaneously breathing rather than in apneic children for airway interventions.

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“…NHF is commonly used in patients with acute respiratory failure and there is a substantial interest in its use during a perioperative period and procedural sedation. [9][10][11] It improves respiratory function primarily by generating low-level positive airway pressure and reducing the re-breathing from anatomical dead space. [12] During sleep, NHF without supplemental oxygen is capable of reducing the re-breathing of CO 2 from anatomical dead space by 45% and lowering minute volume ventilation.…”

Section: Introductionmentioning

confidence: 99%

Respiratory support with nasal high flow without supplemental oxygen in patients undergoing endoscopic retrograde cholangiopancreatography under moderate sedation: a prospective, randomized, single-center clinical trial

Sawase

Ozawa

Yano

et al. 2023

Preprint

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BACKGROUND: Nasal high flow (NHF) may reduce hypoxia and hypercapnia during an endoscopic retrograde cholangiopancreatography (ERCP) procedure under sedation. The authors tested a hypothesis that NHF with room air during ERCP may prevent intraoperative hypercapnia and hypoxemia. METHODS: In the prospective, open-label, single-center, clinical trial, 75 patients undergoing ERCP performed with moderate sedation were randomized to receive NHF with room air (40 to 60 L/min, n = 37) or low-flow O2 via a nasal cannula (1 to 2 L/min, n = 38) during the procedure. Transcutaneous CO2, peripheral arterial O2 saturation, a dose of administered sedative and analgesics were measured. RESULTS: The primary outcome was the mean time-weighted total PtcCO2 of 47.2 mmHg in the NHF group and 48.2 mmHg in the LFO group, with no significant difference (-0.97, 95% CI -3.35 – 1.41, p = 0.421). In secondary outcome analysis, the duration of hypercapnia did not differ markedly between the two groups either [median (range) in the NHF group: 7 (0 – 99); median (range) in the LFO group: 14.5 (0 – 206); p = 0.313] and the occurrence of hypoxemia during an ERCP procedure under sedation was observed in 3 patients (8.1%) in the NHF group and 2 patients (5.3%) in the LFO group, with no significant difference (p = 0.674). CONCLUSIONS: Application of NHF with air did not reduce marked hypercapnia during ERCP under sedation relative to LFO. However, there was no significant difference in occurrence of hypoxemia between the two groups that indicates an improvement of gas exchanges by NHF. Trial registration jRCTs072190021 (https://jrct.niph.go.jp/en-latest-detail/jRCTs072190021) The full date of first registration on jRCT: 26/08/2019

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A Nasal High-Flow System Prevents Upper Airway Obstruction and Hypoxia in Pediatric Dental Patients Under Intravenous Sedation

Cited by 10 publications

References 30 publications

The clinical advantage of nasal high-flow in respiratory management during procedural sedation: A scoping review on the application of nasal high-flow during dental procedures with sedation

The clinical advantage of nasal high-flow in respiratory management during procedural sedation: A scoping review on the application of nasal high-flow during dental procedures with sedation

Apneic oxygenation in pediatric anesthesia

Respiratory support with nasal high flow without supplemental oxygen in patients undergoing endoscopic retrograde cholangiopancreatography under moderate sedation: a prospective, randomized, single-center clinical trial

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