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Awake craniotomy in a super obese patient using high flow nasal cannula oxygen therapy (HFNC)

Wachkraniotomie bei superadipöser Patientin unter Nutzung der nasalen High-flow-Sauerstofftherapie (HFNC)

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Abstract

Super obesity with a body mass index (BMI) >50 kg/m2 presents a challenge for the neuroanesthesiologist during awake craniotomy procedures and poses increased perioperative risk of complications, even vis-à-vis morbid obesity. This article presents a super obese patient (BMI 57 kg/m2) with drug-refractory epilepsy and obstructive sleep apnea who underwent left anterior temporal lobectomy through awake craniotomy to preserve language and memory, using warmed humidified high flow nasal cannula (HFNC) oxygen therapy. Awake craniotomy was facilitated by the use of HFNC, which proved essential to prevent airway collapse by creating continuous positive airway pressure through high flow and facilitated intraoperative neurologic language and memory testing while maintaining adequate oxygenation.

Zusammenfassung

Die Superadipositas mit einem Body-Mass-Index (BMI) >50 kg/m2 stellt den Neuroanästhesisten während der Wachkraniotomie vor spezielle Herausforderungen. Diese Patientengruppe birgt ein erhöhtes Risiko für perioperative Komplikationen, sogar im direkten Vergleich zu Patienten mit Adipositas permagna. In diesem Beitrag wird die anästhesiologische Versorgung einer superadipösen Patientin (BMI 57 kg/m2) mit medikamentenrefraktärer Epilepsie und obstruktiver Schlafapnoe zur Wachkraniotomie vorgestellt. Bei geplanter linksseitiger, anterioren Temporallappenresektion wurde die Wachkraniotomie gewählt, um möglichst Sprache und Gedächtnis zu erhalten. Dabei kam die nasale High-flow-Sauerstofftherapie („high flow nasal cannula“ [HFNC]) mit erwärmtem und befeuchtetem Sauerstoff/Luft Gemisch zum Einsatz. Die Wachkraniotomie wurde durch den Einsatz der HFNC erleichtert, da ein Kollaps der oberen Atemwege zu jedem Zeitpunkt durch den erhöhten Gasfluss (40–60 L/min) erfolgreich vermieden werden konnte. Durch den hohen Fluss wurde ein kontinuierlich positiver Atemwegsdruck erzeugt, der änlich wie CPAP („continuous positive airway pressure“), eine Spontanatmung mit Schienung der Atemwege erreichte. Des Weiteren gestaltete sich der intraoperative neurologische Sprach- und Gedächtnistest bei Aufrechterhaltung einer ausreichenden und kontrollierter Sauerstoffzufuhr (inspiratorische Sauerstofffraktion [FiO2]: 0.4) als unproblematisch. Die Resektion wurde unter Erhaltung von Sprache und Gedächtniss erfolgreich durchgeführt. Die Operation wurde unter Sedierung und Anwendung der HFNC (60 L/min, FiO2 0.65) beendet. Der weitere Verlauf im Aufwachraum und Krankenhaus gestaltete sich unproblematisch, so dass die Patientin am vierten post-operativen Tag nach Hause entlassen wurde.

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Authors and Affiliations

  1. Department of Anesthesia & Peri-operative Medicine, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada

    S. Banik MBBS, MD, DM

  2. Department of Clinical Neurological Sciences, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada

    A. G. Parrent MD, FRCSC

  3. Departments of Anesthesia & Peri-operative Medicine and Physiology & Pharmacology, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, Canada

    R. R. Noppens MD, PhD, FEAMS, FRCPC

Authors
  1. S. Banik MBBS, MD, DM
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  2. A. G. Parrent MD, FRCSC
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  3. R. R. Noppens MD, PhD, FEAMS, FRCPC
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Correspondence to R. R. Noppens MD, PhD, FEAMS, FRCPC.

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Conflict of interest

S. Banik, A.G. Parrent and R.R. Noppens declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. For images or other information within the manuscript which identify patients, consent was obtained from them and/or their legal guardians.

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Banik, S., Parrent, A.G. & Noppens, R.R. Awake craniotomy in a super obese patient using high flow nasal cannula oxygen therapy (HFNC). Anaesthesist 68, 780–783 (2019). https://doi.org/10.1007/s00101-019-00695-4

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  • DOI: https://doi.org/10.1007/s00101-019-00695-4

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