engleski

Case Report: High-flow nasal oxygen therapy during anesthesia of tracheotomized patient undergoing endobronchial ultrasound (EBUS) examination

The anesthetic procedure of a tracheotomized patient with high-flow nasal oxygenation (HFNO) for performing diagnostic endobronchial ultrasound (EBUS) is presented. In Croatia, EBUS has been in use since 2012 and in the world since 2006 for the diagnosis of hilar and/or mediastinal lymphadenopathy and lung tumors. To successfully perform EBUS, a patient must be calm, breathe spontaneously, and have no tracheal reflexes. A 71-year-old male patient, weighing 90 kg, classified as ASA III, and tracheotomized due to the total laryngectomy of operated planocellular carcinoma two years ago. EBUS was indicated due to infiltration of lower right lung lobe and enlarged lymphatic nodes in the mediastinum. During the procedure, blood pressure, respiration rate, heart rate, electrocardiogram (ECG), and oxygen saturation were monitored. Intravenous cannula with an infusion of 500 mL 0.9% NaCl was placed. The patient was sedated with midazolam (2.5 mg), n-fentanyl (10 mcg) and propofol (100 mg bolus followed by a continuous maintenance dose of 4 mg/min). AIRVO2 was used to support ventilation. High-flow nasal oxygen was administered through the nasal catheter. A cannula was removed from the tracheotomized patient. The nasal end of the catheter was held on the tracheotomy site during the EBUS (Figure 1). During procedure lasted for 15 minutes the patient was respirable and hemodynamically stable, spontaneously breathing humidified air/oxygen mixture with a 97% oxygen, heated to 37C and a volume of 60 l/min. The ventilation was satisfactory with the peripheral oxygen saturation of 96±4%. Systolic blood pressure was 126±20 mm Hg and diastolic 68±7 mm Hg. The heart rate was 60±4/ min. The patient woke up neatly, with no complications. We have shown that the application of high-flow nasal oxygen therapy during anesthesia for EBUS yields excellent Results and should be used in the future.

high-flow nasal oxygen therapy ; endobronchial ultrasound ; EBUS ; anesthesia

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