Dr Darren Braude of New Mexico, USA once told me quite sagely : ” Minh, if you gave me all the time in the world, I could intubate just about anyone..the problem is that when you render someone apneic, the oxygenation starts to fall and you dont have all the time in the world.”
Now most of our readers would be familiar with the NODESAT strategy advocated by Dr Levitan, right?
I always find it strange talking to colleagues from anaesthesia or residents who are spending time in an anaesthesia rotation, and they tell me that anaesthetic doctors often respond with the suggestion of NODESAT for an emergency RSI with surprise, confusion and often disdain/scorn.
This is incredible as the concept of NODESAT or apneic oxygenation was first described by the anaesthetic community
And this latest 2013 paper in Otolaryngology – Head and Neck surgery journal describes apneic oxygenation once again!
Tips from the article :
- If you get a catheter down near the carina, within the trachea and deliver 0.5l/min oxygen flow , adequate apneic oxygenation can occur. Caveat is adequate denitrogenation prior to initiation of apneic oxygenation. Not so useful concept in EM/CCM but good to know this is not just a crazy idea dreamt up by EM/CCM doctors!
- Extreme Obesity and pulmonary restrictive conditions may be unsuitable for apneic oxygenation
- Maximum apnea time in this study was 45 min!
- maximum ETCO2 level recorded was 89, so CO2 will rise with apnea time . Beware patients with elevated ICP!