High-flow nasal oxygenation for anesthetic management

Abstract

High-flow nasal oxygenation (HFNO) is a promising new technique for anesthesiologists. The use of HFNO during the induction of anesthesia and during upper airway surgeries has been initiated, and its applications have been rapidly growing ever since. The advantages of this technique include its easy set-up, high tolerability, and its abilities to produce positive airway pressure and a high fraction of inspired oxygen and to influence the clearance of carbon dioxide to some extent. HFNO, via a nasal cannula, can provide oxygen both to patients who can breathe spontaneously and to those who are apneic; further, this technique does not interfere with bag-mask ventilation, attempts at laryngoscopy for tracheal intubation, and surgical procedures conducted in the airway. In this review, we describe the techniques associated with HFNO and the advantages and disadvantages of HFNO based on the current state of knowledge.

Airway management in a patient with an intratracheal tumor near the carina by a two-stage operation

“… 12 Using HFNO, apnea time can be safely extended in various airway surgeries. 5 In this case, preoperative airway examination did not present any problems in upper airway, thereby suggesting that HFNO could be used safely in this patient with the maneuver of maintaining upper airway patency, such as jaw thrust. 13 Therefore, trachea was not intubated, and HFNO was used to maintain saturation during mass biopsy.…”

“… 2 Therefore, tubeless technique with apneic oxygenation performed by a well-communicated team with a concrete strategy can be considered. 5 Here, we introduce a method of securing airway by performing a two-stage operation for intratracheal tumors causing partial obstruction near the carina.…”

<p>Airway Management with Dexmedetomidine and High-Flow Nasal Cannula in a Patient with Deep Neck Infection</p>

“…15 High-flow nasal cannulas are able to titrate fractional inspired oxygen up to 1.0 and consistently deliver highly oxygenated flow to the alveoli because they can provide higher flow rates than conventional inspiratory flow, and can decrease entrapment of room air. 16 High-flow nasal cannula generates a low-level PEEP effect, washout of the pharyngeal dead space, reduction of the "work of breathing", increased alveolar recruitment, and improved mucociliary clearance and patient comfort. 17 It is reportedly superior to conventional oxygenation techniques in specific groups of patients who need tracheal intubation in the operating room such as obese patients and pregnant patients, or patients requiring rapid-sequence induction of anesthesia, and in such cases, it may be an effective technique for delaying hypoxemia during anesthesia management.…”

“…17 It is reportedly superior to conventional oxygenation techniques in specific groups of patients who need tracheal intubation in the operating room such as obese patients and pregnant patients, or patients requiring rapid-sequence induction of anesthesia, and in such cases, it may be an effective technique for delaying hypoxemia during anesthesia management. 16 Mortality from failure of airway management still occurs in patients with severe deep neck infection. 18 Securing the airway remains an ongoing challenge for anesthesiologists.…”

High-Flow Nasal Cannula Oxygen Therapy Can Be Effective for Patients in Acute Hypoxemic Respiratory Failure with Hypercapnia: a Retrospective, Propensity Score-Matched Cohort Study

“…2, 3 In addition, HFNC therapy is also helpful for post extubation respiratory failure and invasive airway procedure such as intubation and bronchoscopy. [4][5][6] In some patients with chronic lung disease (CLD), high-flow oxygen supply can aggravate hypercapnia, 7, 8 and noninvasive ventilation (NIV) is strongly recommended in patients with hypercapnic RF 9 ; therefore, meticulous care is required in such cases when using an HFNC. However, in clinical practice, physicians have been using HFNC therapy frequently not only in patients with de novo AHRF but also in patients with CLD.…”