Airway interventions during intravenous anesthesia in children undergoing direct laryngoscopy for surgical procedures using high flow versus low flow nasal oxygen. Flowkid
Pediatric anesthesia, general anesthesia, oxygen inhalational therapy, airway management, airway surgery, supraglottoplasty, laryngomalacia
Published online: Mar 06 2026
Abstract
Background: Direct laryngoscopy in pediatric patients presents anesthetic challenges, particularly in maintaining airway patency and oxygenation. High-flow nasal oxygen therapy (Optiflow™) has been proposed as an alternative to conventional low-flow oxygen, potentially improving mucosal hydration and respiratory stability.
Objectives: This study compared airway responses and anesthetic interventions when using high-flow and low- flow oxygen in children undergoing direct laryngoscopy for supraglottoplasty. The impact of humidified, heated air on postoperative mucosal quality and surgical conditions was also assessed.
Design and setting: A prospective randomized controlled study conducted in the operating rooms of Antwerp University Hospital.
Materials and methods: The primary endpoint was a composite endpoint, namely airway responses and/or interventions (ARIN) and consisted of the incidence of airway responses, including desaturation (SpO2 < 90% for >30 sec), bradycardia/tachycardia (≥30% change from baseline), and need for airway interventions (mask ventilation, nasopharyngeal airway, or intubation). Secondary endpoints included postoperative mucosal quality and surgeon satisfaction.
Results: ARIN occurred in 74% of patients, with no significant difference between groups (p=0.628). The number of ARIN per patient was higher in the low flow group (n=33 vs n=10), although not statistically significant (p=0.621). Sub analysis showed a slightly higher number of patients with desaturation in the low flow oxygen group (n=2 vs n=3), though total desaturation events were higher in the low-flow group (n=8 vs. n=2). Apnea occurred in 5 (55.6%) high-flow and 7 (70%) low-flow patients. Intubation was required in two (20%) low-flow patients but none in the high-flow group (p=0.167). Postprocedural mucosal quality was significantly better in high-flow patients (p<0.001). Surgeon satisfaction was slightly higher in the high-flow group (p=0.496).
Conclusion: While high-flow oxygen did not significantly reduce airway interventions, it improved mucosal hydration. Further studies with larger samples are needed to confirm these findings.
