Spontaneous Respiration Using Intravenous Anesthesia and High-Flow Nasal Oxygen (STRIVE Hi) Management of Acute Adult Epiglottitis: A Case Report

Abstract

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High-flow nasal oxygenation for anesthetic management

“…A male patient who had acute epiglottitis requiring emergency tracheal intubation [44] exhibited the following characteristics: an airway assessed as a Mallampati score of 2, a thyromental distance of > 6 cm, poor dentition, adequate mouth opening and neck range of movement, and an easily palpable cricothyroid membrane. Despite the administration of intravenous antibiotics and steroids, the airway obstruction progressed rapidly and required airway intervention.…”

“…Anesthesia needs to be maintained with intravenous anesthesia techniques, such as the TCI of propofol [44,70,72,73,75,79] or its continuous infusion [59,68,71,76,78], because inhalational anesthetic agents cannot be administered via the HFNO system as they would be washed out with the high flow of gases, thereby not facilitating the adequate depth of anesthesia [84].…”

“…The reported flow rates of HFNO vary from 50 L/min [75] to 80 L/min [44,59,70–73,78,79] in adults, and a flow rate ≥ 50 L/min appears to be adequate. In children, the flow rate should be adjusted based on the body weight [68,76].…”

“…HFNO may be used both in patients who are apneic [59,68,71–73,75,78,79] and in those who are breathing spontaneously [44,70,74,76,77]. The preservation of spontaneous breathing may permit a better control on the increase in carbon dioxide, airway patency, and oxygenation [44]. Additionally, spontaneous breathing may aid surgeons in locating the glottis by facilitating the confirmation of bubbling or the movement of the vocal cords even in the presence of severe laryngeal edema obscuring the anatomy.…”

“…In emergencies such as acute epiglottitis [44] or supraglottic-pharyngeal stenosis [72], clinicians should always keep in mind the possibility of a failure of HFNO and a priori prepare for emergency tracheostomy. The front of the neck should be evaluated thoroughly preoperatively, and the surgeon should be immediately available in the event of complete airway obstruction.…”