Supraglottic jet oxygenation and ventilation assisted fiberoptic intubation in a paralyzed patient with morbid obesity and obstructive sleep apnea: a case report

Hansheng Liang, Yuantao Hou, Huafeng Wei, Yi Feng, Hansheng Liang, Yuantao Hou, Huafeng Wei, Yi Feng

Abstract

Background: Hypoxia is a major concern and cause of morbidity or mortality during tracheal intubation after anesthesia induction in a pathological obese patient with obstructive sleep apnea (OSA). We introduce a case using Supraglottic jet oxygenation and ventilation (SJOV) to promote oxygenation/ventilation during fiberoptic intubation in a paralyzed patient with morbid obesity and OSA.

Case presentation: A 46-year-old man weighting 176 kg with BMI 53.7 kg/m2 was scheduled for gastric volume reduction surgery to reduce body weight under general anesthesia. SpO2 decreased during induction, and two hand pressured mask ventilation partial failed. We then placed WEI Nasal Jet Tube (WNJ) in the patient's right nostril to provide SJOV. Then fiberoptic bronchoscopy guided endotracheal intubation was performed via mouth approach, and vital signs were stable. The operation was successfully completed after 3 h. Patient recovered smoothly in hospital for 8 days and did not have any recall inside the operating room.

Conclusion: SJOV via WNJ could effectively maintain adequate oxygenation/ventilation during long time fiberoptic intubation in an apnea patient with morbid obesity and OSA after partial failure of two hand pressured mask ventilation, without obvious complications. This may provide a new effective approach for difficult airway management in these patients.

Keywords: Difficult airway; Fiberoptic bronchoscope; Intubation; Jet ventilation; OSA; Obesity; Oxygenation; Supraglottic.

Conflict of interest statement

Ethics approval and consent to participate

A local ethics committee ruled that no formal ethics approval was required in this particular case.

Consent for publication

Written informed consent was obtained from the patient for publication.

Competing interests

Huafeng Wei is the inventor of the WEI Nasal Jet Tube (WEI NASAL JET or WNJ), which was used to generate SJOV in this study. The University of Pennsylvania initiated and granted the patent application for the WNJ in several countries, including the United States, China, Europe, Japan, Canada, Australia, and Brazil. The other authors have no potential competing interests to declare.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Components and assembly of the WEI Nasal Jet Tube (WNJ) and automatical jet ventilator: PetCO2 = end tidal CO2 pressure (Compliance with ethical standards: The automatical jet ventilator-TKR-400 and WNJT upon examination and approval by the company, pictures can be used)

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