SuperNO2V device use in awake craniotomy patients during monitored anesthesia care: a case report

Awake craniotomy under monitored anesthesia care (MAC) enables real-time neurophysiologic evaluation, essential for preserving function in critical brain regions. Effective airway management is crucial, especially in patients with obesity or obstructive sleep apnea. The SuperNO2VA device, a noninvasive ventilation system, enhances oxygenation and improves patient outcomes. This case highlights its utility in managing a high-risk patient undergoing awake craniotomy.

A 32-year-old male with a body mass index (BMI) of 33.21 kg/m², focal seizures, and a Mallampati Grade III airway underwent awake craniotomy. After sedation induction, he experienced oxygen desaturation to SpO₂ 87%, despite the use of a nasal trumpet and oxygen delivery at 6 L/min via nasal cannula. The SuperNO2VA device was applied with positive end-expiratory pressure at 20 mmHg, restoring SpO₂ >90% for the duration of neuromonitoring. Following the conclusion of the case, the patient was transitioned to room air.

This case demonstrates the SuperNO2VA device's effectiveness in managing hypoxemia in high-risk MAC procedures. Its precise oxygen delivery and noninvasive ventilation were highly advantageous in maintaining oxygenation in patients while meeting fire safety requirements.

The SuperNO2VA device is a valuable tool for airway management during awake craniotomy in patients with challenging physiologic profiles. Its ability to stabilize oxygenation highlights its potential for broader applications in high-risk surgical settings.