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MEASUREMENT OF EXHALED NITRIC OXIDE IN PRE-SCHOOL CHILDREN.

Davinia E. Withington, FRCA, T. AlAyed, MD^* and G. Michael Davis, MD

^* Departments of Anaesthesia and Paediatrics, Divisions of Critical Care Medicine and
Respirology,
Montréal Children's Hospital, Montréal, Québec H3H 1P3

INTRODUCTION

Elevated exhaled nitric oxide (eNO) levels have been demonstrated in inflammatory airway conditions e.g. asthma¹. This study measured eNO in normal preschool children for whom there is little data available and in whom the prevalence of asthma high².

METHODS

Fifty children, 1-7 years old, undergoing elective surgery, excluding airway procedures, were recruited with parental written informed consent. Children with known respiratory disease or acute viral infections were excluded. Gas for eNO measurement was collected in a non-diffusing bag³: 1. Via the mask after inhalational induction of anaesthesia 2. Via endotracheal tube (ETT) or laryngeal mask airway (LMA), 3. during emergence. Measurement was off-line by chemiluminescent analyser (Sievers).

RESULTS

Mean eNO by mask was 10.23 (95%CI 8.7-11.1)ppb after induction and 8.35 (95%CI 5.9-10.8)ppb on emergence (NSD). Mean eNO for ETT group (n=25) was 0.75 (95% CI 0.4-1.1)ppb (p<0.0001 vs mask); mean eNO for LMA group (n=25) was 2.6 (95% CI 2.0-3.2ppb) which differed from mask (p<0.0001) and from ETT values (p<0.0001).

DISCUSSION

Most eNO is produced by the upper airway in healthy pre-school children. The lower airway constitutive eNO production is very low. The LMA does not completely isolate the upper airway and current mask collection techniques allow significant contamination of samples by sino-nasal eNO production in young children.

REFERENCES

1 Eur.J.Pediatr. 155: 698–701

2 Pediatr Pulmonol 27: 54–58.

3 Am.J.Resp Crit.Care Med 153: 1631–1635.

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