Anesth Pain Med.  2021 Oct;16(4):338-343. 10.17085/apm.21022.

Awake craniotomy using a high-flow nasal cannula with oxygen reserve index monitoring - A report of two cases -

• Gook J
• Kwon JH
• Kim K
• Choi JW
• Chung IS
• Lee J

• KMID: 2524445
• DOI: http://doi.org/10.17085/apm.21022

Abstract

Background
Awake craniotomy is a well-tolerated procedure for the resection of brain tumors residing within or close to the eloquent cortical areas. Monitored anesthesia care (MAC) is a dominant anesthetic approach for awake craniotomy; however, it is associated with inherent challenges such as desaturation and hypercapnia, which may lead to various complications. The prevention of respiratory insufficiency is important for successful awake craniotomy. As measures to avoid respiratory depression, the use of high-flow nasal cannula (HFNC) can improve patient oxygenation and monitor the oxygen reserve index (ORi) to detect hypoxia earlier. Case: We report two cases of awake craniotomy with MAC using HFNC and ORi. We adjusted the fraction of inspired oxygen of the HFNC according to the ORi level. The patient underwent successful awake craniotomy without a desaturation event or additional airway intervention.
Conclusions
Combined HFNC and ORi monitoring may provide adequate oxygen reserves in patients undergoing awake craniotomy.

Keyword

Airway obstruction; Craniotomy; Oxygen reserve; Respiratory insufficiency; Sleep apnea, obstructive

Figure

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  Fig. 1. Intraoperative ORi, SpO2, and FiO2 of HFNC in Case 1. ORi: oxygen reserve index, SpO2: pulse oximetry saturation, FiO2: fraction of inspired oxygen, HFNC: high flow nasal cannula. This figure reveals the change of ORi and SpO2 over time and FiO2 we adjusted in Case 1. We maintained ORi above 0.2 by adjusting the FiO2 and flow rate of HFNC. The time and arrow in parentheses is the same as the time and arrow in Table 1. ① ORi suddenly decreased to zero (time from 1:10 to 1:30). ② ORi recovered by increasing FiO2 to 0.56. ③ During the speech test (time from 3:00 to 3:50), the ORi suddenly dropped to zero. ④ SpO2 reacted later than ORi, it decreased to 95%.

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