From the Guidelines
The main difference between insufflation technique and apneic technique is the method of oxygen delivery, with insufflation involving the administration of oxygen at 3–10 litres min-1 via a nasal catheter or oral tube, whereas apneic oxygenation techniques include nasopharyngeal insufflation with the aid of an oxygen cannula at a flow rate of 5 L/min or high flow nasal oxygen.
Key Differences
- Insufflation Technique: + Involves administration of oxygen at 3–10 litres min-1 via a nasal catheter or oral tube + Can provide 10 min of ‘safe’ apnoea time in ASA I or II patients with unobstructed airways 1
- Apneic Technique: + Includes nasopharyngeal insufflation with the aid of an oxygen cannula at a flow rate of 5 L/min or high flow nasal oxygen + Can prolong the arterial oxygen desaturation time, with a doubling of this time during a controlled trial comparing nasopharyngeal insufflation to apnoeic oxygenation after conventional pre-oxygenation in both cases 2 ### Comparison of Techniques Both techniques aim to prolong the safe apnoea time, but they differ in their approach. The insufflation technique is a more traditional method, whereas the apneic technique includes newer methods such as high flow nasal oxygen. The choice of technique may depend on the patient's condition, the availability of equipment, and the clinician's preference.
Clinical Implications
In clinical practice, the choice of technique should be based on the individual patient's needs and the clinician's expertise. For example, in obese patients or those in critical condition, apneic oxygenation techniques may be beneficial in preventing arterial oxygen desaturation 2. On the other hand, the insufflation technique may be suitable for patients with unobstructed airways.
Limitations
It is essential to note that the evidence is not exhaustive, and more research is needed to fully understand the differences between these techniques. However, based on the available evidence, both techniques can be effective in prolonging the safe apnoea time, and the choice of technique should be based on individual patient needs and clinician expertise.
From the Research
Differences between Insufflation Technique and Apneic Technique
The insufflation technique and apneic technique are two different methods used in airway management during anesthesia. The main difference between the two techniques is the way oxygen is delivered to the patient.
- Insufflation Technique: This technique involves delivering oxygen through a nasal cannula or a catheter inserted into the nostril, providing a high flow of oxygen to the patient 3. The insufflation technique, also known as Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE), has been shown to be effective in providing pre- and apneic oxygenation during anesthesia induction 4, 5, 6, 3.
- Apneic Technique: This technique involves a period of apnea, or absence of breathing, during which the patient is not ventilated 7, 4, 5, 6. The apneic technique can be used in conjunction with the insufflation technique to provide oxygen to the patient during the apneic period.
Key Findings
Some key findings from the studies include:
- The insufflation technique using THRIVE has been shown to be effective in providing pre- and apneic oxygenation during anesthesia induction, with improved oxygenation and prolonged safe apnea time compared to standard facemask ventilation 3.
- The apneic technique can be used safely in patients undergoing laryngeal and tracheal surgeries, with no significant desaturation or complications reported 4, 5, 6.
- The use of transcutaneous carbon dioxide monitoring during the apneic period can help detect rates of CO2 rise and ensure adequate ventilation 6.
Comparison of Techniques
A comparison of the two techniques shows that:
- The insufflation technique using THRIVE provides better oxygenation and longer safe apnea time compared to the apneic technique alone 3.
- The apneic technique can be used safely in patients undergoing certain types of surgery, but may require closer monitoring of oxygen saturation and carbon dioxide levels 4, 5, 6.