• Eun-Hee Kim, Ji-Hyun Lee, Young-Eun Jang, Sang-Hwan Ji, Sung-Ae Cho, Jin-Tae Kim, and Hee-Soo Kim.
• From the Department of Anaesthesiology and Pain medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea (EH-K, JH-L, YE-J, SH-J, SA-C, JT-K, HS-K).
• Eur J Anaesthesiol. 2021 Oct 1; 38 (10): 1012-1018.

BackgroundHypoxaemia occurs frequently in infants during anaesthetic induction.ObjectiveWe evaluated the effect of positive end-expiratory pressure during anaesthesia induction on nonhypoxic apnoea time in infants.DesignRandomised controlled trial.SettingTertiary care children's hospital, single centre, from November 2018 to October 2019.PatientsWe included patients under 1 year of age receiving general anaesthesia.InterventionWe assigned infants to a 7 cmH2O or 0 cmH2O positive end-expiratory pressure group. Anaesthesia was induced with 0.02 mg kg-1 atropine, 5 mg kg-1 thiopental sodium and 3 to 5% sevoflurane, and neuromuscular blockade with 0.6 mg kg-1 rocuronium. Thereafter, 100% oxygen was provided via face mask with volume-controlled ventilation of 6 ml kg-1 tidal volume, and either 7 cmH2O or no positive end-expiratory pressure. After 3 min of ventilation, the infants' trachea was intubated but disconnected from the breathing circuit, and ventilation resumed when pulse oximetry reached 95%.Main Outcome MeasureThe primary outcome was nonhypoxic apnoea time defined as the time from cessation of ventilation to a pulse oximeter reading of 95%, whereas the secondary outcome was the incidence of significant atelectasis (consolidation score ≥2) assessed by lung ultrasound.ResultsSixty patients were included in the final analysis. Apnoea time in the 7 cmH2O positive end-expiratory pressure group (105.2 s) increased compared with that in the control group (92.1 s) (P = 0.011, mean difference 13.0 s, 95% CI, 3.1 to 22.9 s). Significant atelectasis was observed in all patients without positive end-expiratory pressure and 66.7% of those with 7 cmH2O positive end-expiratory pressure (P = 0.019, 95% CI, 1.7 to 563.1, odds ratio 31.2).ConclusionPositive end-expiratory pressure during anaesthesia induction with face mask ventilation increased nonhypoxic apnoea time in infants.Clinical Trial Registrationwww.clinicaltrials.gov, NCT03540940.Copyright © 2020 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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