The SuperNO2VA to treat upper airway obstruction and respiratory compromise after major head and neck surgery: a case report

Abstract

Postoperative pulmonary complications are common after major neck surgery, with airway compromise a leading cause for hypoxemia, hypercarbia, and reintubation. There are advantages to tracheal extubation upon emergence from anesthesia when appropriate. Recognizing that reintubation in the setting of upper airway obstruction or respiratory compromise may be challenging with presence of a cervical collar or anatomic changes following surgery. We present a 42-year-old man who underwent emergent cervical decompression and fusion with corpectomy following blunt force trauma. Upon emergence, a deep extubation was performed directly to the SuperNO2VA nasal mask connected to a Mapleson C circuit. This is a nasal positive pressure device used to maintain upper airway patency and provide ventilatory support during emergence. While in the intensive care unit, the patient was weaned to nasal cannula. However, mental status remained poor; and upper airway obstruction ensued leading to hypoxemic respiratory insufficiency, as shown by arterial blood gas. The SuperNO2VA was replaced with normalization of respiratory function and blood gas analysis. After 14 hours, including the use of SuperNO2VA during transport to and use inside the computed tomography scanner, the patient’s mental status recovered and ventilatory support was downgraded to nasal cannula without further events. Nasal positive pressure via the SuperNO2VA device as described may offer an inexpensive, transportable option for providing airway and ventilatory support in high-risk patients with anticipated difficult airways.