Airway management using a nasal high flow system (Optiflow™) during intravenous sedation for dental treatment in an obese patient with intellectual disability

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Abstract

Intravenous sedation (IVS) is useful for the dental treatment of patients with intellectual disability (ID). However, in obese patients, difficulties in airway management can easily lead to oxygen desaturation. Nasal high-flow systems (NHFS) are a new type of device that can supply oxygen at a high flow rate. Several recent studies have shown that the use of an NHFS is very effective for preventing oxygen desaturation, and we have used an NHFS for airway management during IVS for a dental procedure in a patient with severe obesity and ID. Use of the NHFS was approved by the institutional review board of Okayama University Hospital, and written informed consent was obtained from the patient's parents. The dental treatment was planned for a 40-year-old male patient (height: 170 cm ; body weight : 92.1 kg ; body mass index : 31.8) with ID. He had experienced several oxygen desaturation episodes during previous dental sedations because of difficulties encountered during airway management. At this time, the NHFS (Optiflow™) was used for airway management during IVS. Fifty-minutes after the oral administration of 25 mg of midazolam, propofol was continuously infused at a dose of 1.0 μg/ml of the target effect site concentration. The sedation level was maintained at a bispectral index value of 50-70 by adjusting the target concentration of propofol. Initially, 40% oxygen was administered at a rate of 20 l/min via the NHFS. The flow volume was gradually increased up to 50 l/min, and high-flow oxygen was supplied throughout the dental treatment. Neither airway obstruction nor oxygen desaturation was observed during the dental treatment, resulting in no complications such as airway injury. This case suggests that NHFS enabled easy airway management during IVS for dental treatment in an obese patient.

Original languageEnglish
Pages (from-to)207-209
Number of pages3
JournalJournal of Japanese Dental Society of Anesthesiology
Volume44
Issue number2
Publication statusPublished - 2016

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Airway Management
Nose
Intellectual Disability
Tooth
Oxygen
Propofol
Therapeutics
Morbid Obesity
Research Ethics Committees
Midazolam
Airway Obstruction
Informed Consent
Oral Administration
Body Mass Index
Parents
Body Weight
Equipment and Supplies
Wounds and Injuries

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Dentistry(all)

Cite this

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title = "Airway management using a nasal high flow system (Optiflow™) during intravenous sedation for dental treatment in an obese patient with intellectual disability",
abstract = "Intravenous sedation (IVS) is useful for the dental treatment of patients with intellectual disability (ID). However, in obese patients, difficulties in airway management can easily lead to oxygen desaturation. Nasal high-flow systems (NHFS) are a new type of device that can supply oxygen at a high flow rate. Several recent studies have shown that the use of an NHFS is very effective for preventing oxygen desaturation, and we have used an NHFS for airway management during IVS for a dental procedure in a patient with severe obesity and ID. Use of the NHFS was approved by the institutional review board of Okayama University Hospital, and written informed consent was obtained from the patient's parents. The dental treatment was planned for a 40-year-old male patient (height: 170 cm ; body weight : 92.1 kg ; body mass index : 31.8) with ID. He had experienced several oxygen desaturation episodes during previous dental sedations because of difficulties encountered during airway management. At this time, the NHFS (Optiflow™) was used for airway management during IVS. Fifty-minutes after the oral administration of 25 mg of midazolam, propofol was continuously infused at a dose of 1.0 μg/ml of the target effect site concentration. The sedation level was maintained at a bispectral index value of 50-70 by adjusting the target concentration of propofol. Initially, 40{\%} oxygen was administered at a rate of 20 l/min via the NHFS. The flow volume was gradually increased up to 50 l/min, and high-flow oxygen was supplied throughout the dental treatment. Neither airway obstruction nor oxygen desaturation was observed during the dental treatment, resulting in no complications such as airway injury. This case suggests that NHFS enabled easy airway management during IVS for dental treatment in an obese patient.",
author = "Rieko Onishi and Hitoshi Higuchi and Akiko Kawase and Minako Maruhama and Yuka Honda and Shigeru Maeda and Takuya Miyawaki",
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T1 - Airway management using a nasal high flow system (Optiflow™) during intravenous sedation for dental treatment in an obese patient with intellectual disability

AU - Onishi, Rieko

AU - Higuchi, Hitoshi

AU - Kawase, Akiko

AU - Maruhama, Minako

AU - Honda, Yuka

AU - Maeda, Shigeru

AU - Miyawaki, Takuya

PY - 2016

Y1 - 2016

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AB - Intravenous sedation (IVS) is useful for the dental treatment of patients with intellectual disability (ID). However, in obese patients, difficulties in airway management can easily lead to oxygen desaturation. Nasal high-flow systems (NHFS) are a new type of device that can supply oxygen at a high flow rate. Several recent studies have shown that the use of an NHFS is very effective for preventing oxygen desaturation, and we have used an NHFS for airway management during IVS for a dental procedure in a patient with severe obesity and ID. Use of the NHFS was approved by the institutional review board of Okayama University Hospital, and written informed consent was obtained from the patient's parents. The dental treatment was planned for a 40-year-old male patient (height: 170 cm ; body weight : 92.1 kg ; body mass index : 31.8) with ID. He had experienced several oxygen desaturation episodes during previous dental sedations because of difficulties encountered during airway management. At this time, the NHFS (Optiflow™) was used for airway management during IVS. Fifty-minutes after the oral administration of 25 mg of midazolam, propofol was continuously infused at a dose of 1.0 μg/ml of the target effect site concentration. The sedation level was maintained at a bispectral index value of 50-70 by adjusting the target concentration of propofol. Initially, 40% oxygen was administered at a rate of 20 l/min via the NHFS. The flow volume was gradually increased up to 50 l/min, and high-flow oxygen was supplied throughout the dental treatment. Neither airway obstruction nor oxygen desaturation was observed during the dental treatment, resulting in no complications such as airway injury. This case suggests that NHFS enabled easy airway management during IVS for dental treatment in an obese patient.

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