High flow nasal apnoeic oxygenation in a high risk patient

Abstract

High flow nasal oxygenation uses the phenomenon of aventilatory mass flow to provide continuous oxygenation during the apnoeic period between induction of anaesthesia and tracheal intubation. It has been shown to significantly increase the time to desaturation in cases of difficult intubation. We describe a case of a lady with CREST syndrome (a variant of scleroderma) presenting for surgery. Her disease included gastro-eosophageal reflux, a potentially difficult airway and poor left ventricular function. Neuraxial blockade was contraindicated due to coagulopathy and localised cellulitis over her lower back. High flow nasal oxygenation was employed during induction, allowing a slower more controlled induction whilst maintaining haemodynamic stability. We believe this to be a well-tolerated, effective method of increasing apnoea times, giving more flexibility over speed of induction when the classical rapid sequence induction may result in unacceptable cardiovascular instability.