High-flow nasal oxygenation as a method of anesthetic management of patients with «difficult airways»: clinical cases

Surgical treatment of children with pathologies of the oral cavity and upper respiratory tract creates difficulties for both the surgeon and the anesthesiologist. Aim - to show the effectiveness of high-flow nasal oxygenation in preventing hypoxia in patients with "difficult airway" during surgical interventions in the oral cavity. Clinical cases. Two clinical cases are presented: the first patient with post-traumatic ankylosis of the temporomandibular joint, the second with macroglossia on the background of Beckwith-Wiedemann syndrome, who underwent oral surgery. Given the anatomical features of the patients, classical intubation of the trachea under direct laryngoscopy was impossible for them. Both patients underwent fiberoptic intubation of the trachea under the STRIVE Hi (Spontaneous Respiration Using Intravenous Anesthesia and High-Flow Nasal Oxygen) anesthesia technique. High-flow nasal oxygenation was used as the main method of respiratory support. Despite the long period of hypoventilation and apnea, both patients had normal oxygenation and ventilation parameters (SpO2 99-98%, EtCO2 47-48 mm Hg) Conclusions. High-flow nasal oxygenation is an effective method of oxygenation and prevention of hypoxia during the anesthetic management of "difficult airways" in children. Earlier onset of desaturation and hypercapnia in children is associated with young age and smaller functional residual lung capacity. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patients was obtained for the study. The authors declare no conflict of interest.