{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T08:25:25Z","timestamp":1786955125306,"version":"build-2736575974"},"reference-count":42,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["World j. otorhinolaryngol.-head neck surg."],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Limited data exist on cardiocirculatory responses associated with extended periods of apnea during administration of high\u2010flow nasal oxygen for laryngologic surgery (apneic oxygenation with HFNO, AO\u2010HFNO). The possibility of hemodynamic compromise in the settings of acute hypercapnia, respiratory acidosis, hyperoxia, and IV anesthesia requires further investigation. This trial investigated the hemodynamic safety profile of prolonged AO\u2010HFNO in adult patients undergoing laryngologic surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using invasive hemodynamic monitoring, we conducted prospective, randomized, patient\u2010blinded, two\u2010arm parallel pilot trial in 20 adult patients (ASA physical status 1\u20133) undergoing elective laser laryngologic surgery expected to last over 40\u2009min. The patients were randomly assigned to receive either AO\u2010HFNO or conventional mechanical ventilation using a laser endotracheal tube (ETT). The primary outcome was the effect of prolonged permissive hypercapnia and IV anesthesia on intraoperative cardiocirculatory responses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Extended AO\u2010HFNO led to the development of moderate to severe hypercapnia with PaCO\n                      <jats:sub>2<\/jats:sub>\n                      reaching as high as 113\u2009mmHg and pH as low as 6.96. These changes were accompanied by induction of hyperdynamic state characterized by increase in heart rate (maximum median changes of ~38%), cardiac index (~36%) and decrease in systemic vascular resistance index (~46%). Maximum median decrease in mean arterial pressure was ~28% and was not associated with the need for extra vasopressor support compared to ETT group. There were no intraoperative or immediate postoperative complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prolonged AO\u2010HFNO is associated with a safe intraoperative hemodynamic profile during extended periods of apnea for selected patients undergoing laryngologic surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjo2.70154","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T07:52:56Z","timestamp":1786953176000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hemodynamic Effects of Prolonged Apneic Oxygenation in Laryngologic Surgery: A Randomized Controlled Pilot Trial"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5586-387X","authenticated-orcid":false,"given":"Vladimir","family":"Nekhendzy","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Stanford University Medical Center Stanford California USA"},{"name":"Department of Otolaryngology<b>\u2013<\/b>Head and Neck Surgery Stanford University Medical Center Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hendrikus J.","family":"Lemmens","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Stanford University Medical Center Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0175-482X","authenticated-orcid":false,"given":"Amit R.","family":"Saxena","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Stanford University Medical Center Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0334-295X","authenticated-orcid":false,"given":"Brita M.","family":"Mittal","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Stanford University Medical Center Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3983-0805","authenticated-orcid":false,"given":"Edward J.","family":"Damrose","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine Stanford University Medical Center Stanford California USA"},{"name":"Department of Otolaryngology<b>\u2013<\/b>Head and Neck Surgery Stanford University Medical Center Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9795-6452","authenticated-orcid":false,"given":"C. 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