The time you buy before desaturation is made before the laryngoscope goes in. Pre-oxygenate every patient to denitrogenate the lungs — a tight-fitting mask with a high flow until end-tidal oxygen is high — and the safe apnoea window lengthens substantially.
In patients who desaturate quickly — infants and small children, the obese, pregnant women, the critically ill — add apnoeic oxygenation via nasal cannula during the attempt. It continues delivering oxygen while you have no ventilation, extending the time before saturation falls and turning a rushed attempt into a controlled one.
This is established airway practice and costs almost nothing. It matters most exactly where first-attempt success is hardest and the margin for a second look is smallest.
- Pre-oxygenate every patient to a high end-tidal oxygen before induction, with a well-sealed mask.
- Add nasal apnoeic oxygenation in patients who desaturate fast — infants, the obese, pregnant, critically ill.
- Use the extra time for a controlled first attempt rather than a hurried one.
- Have a plan and your next device ready before the first look, not after it fails.
Why it matters
The safe apnoea time is set before the attempt, and it is longest exactly where intubation is hardest.
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