Oxygenation techniques in head and neck surgery

Adequate patient oxygenation during head and neck surgery is challenging as patients may have complex underlying pathologies and patient comorbidities, coupled with the need for shared airway access. Recent advances such as high-flow nasal oxygen, double jet ventilation (low frequency superimposed on high frequency) and ultra-narrow tracheal tube ventilation, have expanded the oxygenation options available. However, case selection and multidisciplinary team work coupled with a comprehensive understanding and high-quality training remain key to the safe, effective delivery of these approaches.

Emerging evidence supports the use of high-flow nasal oxygen for extended periods of apneic oxygenation, with benefits in maximizing surgical exposure, though concerns persist over the fire risk during certain procedures. Jet ventilation provides versatility via its various anatomical routes and modes of delivery; the newest devices offering additional safety features as well as double jet capability to improve carbon dioxide clearance. Ultra-narrow tracheal tubes, coupled with flow-controlled ventilation, offer airway protection and enhanced glottic visibility.

The optimal oxygenation strategy in head and neck surgery must integrate patient-specific pathology and physiology with surgical requirements, equipment availability and operator expertise. A dynamic, team-based approach with predefined rescue plans is essential.