The Role of Oxygen Reserve Index (ORi) in Identifying Early Desaturation During Endolaryngeal Surgery: A Randomized Clinical Trial

This prospective, single-center, randomized clinical trial was designed to evaluate the role of the Oxygen Reserve Index (ORi) in the early detection of hypoxemia during apneic intermittent ventilation in adult patients undergoing elective endolaryngeal surgery under general anesthesia. Endolaryngeal procedures require shared airway management and frequently involve apneic periods, during which conventional pulse oximetry may fail to provide timely warning of declining oxygen reserves due to the plateau phase of the oxyhemoglobin dissociation curve. Eligible patients aged 18 years and older with ASA physical status I-III were randomly assigned to either an ORi-monitored group or a control group monitored with standard peripheral oxygen saturation (SpO₂). All patients underwent standardized anesthesia induction, preoxygenation, and apneic intermittent ventilation. In the ORi group, the threshold for resuming ventilation was defined as ORi reaching zero, whereas in the control group ventilation was resumed when SpO₂ decreased to 90%. The primary outcome was the time from the onset of apnea to the predefined reventilation threshold. Secondary outcomes included arterial blood gas parameters (pH, PaO₂, PaCO₂) at the time of reventilation, end-tidal carbon dioxide levels, perioperative lung ultrasound findings, post-anesthesia care unit length of stay, and postoperative respiratory outcomes. This study aims to determine whether ORi monitoring provides earlier and clinically meaningful warning of oxygen reserve depletion compared with conventional pulse oximetry, potentially improving patient safety during shared-airway surgery.