High-flow nasal oxygen for suspension laryngoscopy: a multicenter open-label study

Area of Science:

• Anesthesiology
• Respiratory Medicine
• Otolaryngology

Background:

• Maintaining adequate oxygenation and ventilation during airway procedures under general anesthesia is critical.
• High-flow nasal oxygen (HFNO) is increasingly used for oxygenation support.
• Suspension laryngoscopy requires careful airway management due to potential for airway obstruction and altered ventilation.

Purpose of the Study:

• To evaluate the effectiveness of high-flow nasal oxygen (HFNO) in maintaining blood oxygen saturation (SpO2) during suspension laryngoscopy under general anesthesia.
• To assess the incidence of hypoxemia and hypercapnia when using HFNO in this specific surgical context.

Main Methods:

• A bicenter study included adult patients undergoing suspension laryngoscopy under general anesthesia.
• High-flow nasal oxygen (HFNO) at 70 L/min with 100% fraction of inspired oxygen was initiated after loss of consciousness.
• Blood gas analysis was performed at the end of HFNO, and SpO2 levels were monitored throughout the procedure.

Main Results:

• 17.2% of patients had SpO2 <95% within 15 minutes, and 27.6% had SpO2 <95% throughout the procedure.
• 20.7% of patients required rescue jet ventilation.
• 88.9% of patients exhibited hypercapnia (arterial carbon dioxide tension > 8 kPa) at the end of the procedure.

Conclusions:

• High-flow nasal oxygen (HFNO) is associated with a significant incidence of suboptimal oxygen saturation and hypercapnia during suspension laryngoscopy under general anesthesia.
• HFNO may not be a reliable or sufficient technique for maintaining adequate oxygenation and ventilation in this patient population.
• Alternative or adjunctive methods should be considered for oxygenation support during suspension laryngoscopy.