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

Abstract

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