A Practical Approach to Apneic Oxygenation during Endotracheal Intubation

Patients undergoing general anesthesia with endotracheal intubation are exposed to a brief apnea period that is usually well tolerated. Conventional preoxygenation techniques may not provide adequate time for safe airway management in patients at high risk for desaturation or when an unanticipated difficult airway arises. Continuous oxygen administration during the apnea period, termed apneic oxygenation, can be used in conjunction with traditional pre-oxygenation techniques to prolong the time to patient desaturation when tracheal intubation is attempted. Clinical studies have evaluated the efficacy of apneic oxygenation using multiple techniques, nasopharyngeal catheters, nasal prongs, modified laryngoscopes, and buccal oxygen administration, all proved to be effective at prolonging the duration of apnea, by delaying the onset of hypoxemia.