Application of high-flow nasal cannula oxygenation in the induction of general anesthesia by direct providers: A case series

Abstract

Background: Pressurized mask-assisted ventilation is commonly used during general anesthesia, which often requires the cooperation of two anesthesiologists and creates a severe shortage of anesthesiologists. High-flow nasal cannula oxygenation (HFNCO) is reportedly effective in perioperative airway management, but its safety and efficacy in the induction of general anesthesia by direct providers have not been confirmed. Methods: Twelve patients were enrolled in our study. Their vital signs were recorded before surgery (T0), and HFNCO was continuously applied after admission. Blood gas analysis results were recorded before pre-oxygenation (T1), during anesthetic induction (T2), and before mechanical ventilation (T3). Results: The mean arterial partial pressure of oxygen (PaO2) was 86.6±26.0, 245.3±90.6, and 170.0±99.4 mmHg at T1, T2, and T3, respectively, and the lowest pulse oxygen saturation (SpO2) was 92% at T3. The mean arterial partial pressure of carbon dioxide (PaCO2) was 39.0±6.2, 40.0±5.7, and 50.2±8.7 mmHg, respectively; the highest was 71.1 mmHg. The mean pH was 7.40±0.02, 7.39±0.05, and 7.35±0.06, respectively. One patient switched to pressurized mask-assisted ventilation because of severe hypoxemia (lowest SpO2, 82%) during apnea oxygenation. Conclusions: HFNCO significantly improves oxygenation levels without severe hypercapnia and can be safely applied to general anesthesia induction by direct providers.