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Preventing deoxygenation with high flow nasal cannula oxygen during induction of general anesthesia for rigid bronchoscopy: Two case reports.
Medicine (Baltimore) 2019; 98(27):e15998M

Abstract

RATIONALE

Rigid bronchoscopy under general anesthesia enables performing diagnostic and/or therapeutic procedures in the tracheobronchial tree. As most patients undergoing rigid bronchoscopy have moderate to severe respiratory disease or central airway obstruction, the operators often face the risk of hypoxemia when inserting the rigid bronchoscope into the patients' airway. Applying high flow nasal cannula (HFNC) oxygen therapy before the insertion of the bronchoscope allows to maintain high fractional inspired oxygen (FiO2) and thus leading to maximizing apnea time before desaturation.

PATIENT CONCERNS AND DIAGNOSIS

Case 1: A 70-year-old female patient was diagnosed with lung cancer in the left lower lobe and a tracheal mass of about 2.6 cm * 0.8 cm in size.Case 2: A male patient, 77 years old, 55.7 kg and 157.3 cm in height, had been diagnosed with chronic obstructive pulmonary disease, and was scheduled for the bronchoscopic volume reduction surgery upon exacerbation of his symptoms of dyspnea and cough with sputum.

INTERVENTIONS

Preoxygenation was performed with HFNC (Fisher&Paykel Optiflow Thrive, New Zealand) for 3 minutes before the administration of anesthetic medications. The oxygen flow was set at 50 L/min and the FiO2 at 1.0. SpO2 increased to 100%.

OUTCOMES

The HFNC oxygen has shown its effectiveness in safely maintaining the patients' SpO2 during the prolonged apneic period of inserting bronchoscope.

LESSONS

HFNC oxygen is an effective tool in oxygenating the patients during the induction of rigid bronchoscopy, and that it may be a superior alternative to the conventional method of preoxygenation.

Authors+Show Affiliations

Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

31277092

Citation

Min, Ji Young, et al. "Preventing Deoxygenation With High Flow Nasal Cannula Oxygen During Induction of General Anesthesia for Rigid Bronchoscopy: Two Case Reports." Medicine, vol. 98, no. 27, 2019, pp. e15998.
Min JY, Jo H, Roh K, et al. Preventing deoxygenation with high flow nasal cannula oxygen during induction of general anesthesia for rigid bronchoscopy: Two case reports. Medicine (Baltimore). 2019;98(27):e15998.
Min, J. Y., Jo, H., Roh, K., & Chung, M. Y. (2019). Preventing deoxygenation with high flow nasal cannula oxygen during induction of general anesthesia for rigid bronchoscopy: Two case reports. Medicine, 98(27), pp. e15998. doi:10.1097/MD.0000000000015998.
Min JY, et al. Preventing Deoxygenation With High Flow Nasal Cannula Oxygen During Induction of General Anesthesia for Rigid Bronchoscopy: Two Case Reports. Medicine (Baltimore). 2019;98(27):e15998. PubMed PMID: 31277092.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preventing deoxygenation with high flow nasal cannula oxygen during induction of general anesthesia for rigid bronchoscopy: Two case reports. AU - Min,Ji Young, AU - Jo,Haedeun, AU - Roh,Kyungmoon, AU - Chung,Mee Young, PY - 2019/7/7/entrez PY - 2019/7/7/pubmed PY - 2019/7/16/medline SP - e15998 EP - e15998 JF - Medicine JO - Medicine (Baltimore) VL - 98 IS - 27 N2 - RATIONALE: Rigid bronchoscopy under general anesthesia enables performing diagnostic and/or therapeutic procedures in the tracheobronchial tree. As most patients undergoing rigid bronchoscopy have moderate to severe respiratory disease or central airway obstruction, the operators often face the risk of hypoxemia when inserting the rigid bronchoscope into the patients' airway. Applying high flow nasal cannula (HFNC) oxygen therapy before the insertion of the bronchoscope allows to maintain high fractional inspired oxygen (FiO2) and thus leading to maximizing apnea time before desaturation. PATIENT CONCERNS AND DIAGNOSIS: Case 1: A 70-year-old female patient was diagnosed with lung cancer in the left lower lobe and a tracheal mass of about 2.6 cm * 0.8 cm in size.Case 2: A male patient, 77 years old, 55.7 kg and 157.3 cm in height, had been diagnosed with chronic obstructive pulmonary disease, and was scheduled for the bronchoscopic volume reduction surgery upon exacerbation of his symptoms of dyspnea and cough with sputum. INTERVENTIONS: Preoxygenation was performed with HFNC (Fisher&Paykel Optiflow Thrive, New Zealand) for 3 minutes before the administration of anesthetic medications. The oxygen flow was set at 50 L/min and the FiO2 at 1.0. SpO2 increased to 100%. OUTCOMES: The HFNC oxygen has shown its effectiveness in safely maintaining the patients' SpO2 during the prolonged apneic period of inserting bronchoscope. LESSONS: HFNC oxygen is an effective tool in oxygenating the patients during the induction of rigid bronchoscopy, and that it may be a superior alternative to the conventional method of preoxygenation. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/31277092/Preventing_deoxygenation_with_high_flow_nasal_cannula_oxygen_during_induction_of_general_anesthesia_for_rigid_bronchoscopy:_Two_case_reports L2 - http://Insights.ovid.com/pubmed?pmid=31277092 DB - PRIME DP - Unbound Medicine ER -