High-flow nasal cannula improves clinical efficacy of airway management in patients undergoing awake craniotomy

BACKGROUND: Awake craniotomy requires specific sedation procedure in an awake patient who should be able to cooperate during the intraoperative neurological assessment. Currently, limited number of literatures on the application of high-flow nasal cannula (HFNC) in the anesthetic management for awake craniotomy has been reported. Hence, we carried out a prospective study to assess the safety and efficacy of humidified high-flow nasal cannula (HFNC) airway management in the patients undergoing awake craniotomy. METHODS: Sixty-five patients who underwent awake craniotomy were randomly assigned to use HFNC with oxygen flow rate at 40 L/min or 60 L/min, or nasopharynx airway (NPA) device in the anesthetic management. Data regarding airway management, intraoperative blood gas analysis, intracranial pressure, gastric antral volume, and adverse events were collected and analyzed. RESULTS: Patients using HFNC with oxygen flow rate at 40 or 60 L/min presented less airway obstruction and injuries. Patients with HFNC 60 L/min maintained longer awake time than the patients with NPA. While the intraoperative PaO(2) and SPO(2) were not significantly different between the HFNC and NPA groups, HFNC patients achieved higher PaO(2)/FiO(2) than patients with NPA. There were no differences in Brain Relaxation Score and gastric antral volume among the three groups as well as before and after operation in any of the three groups. CONCLUSION: HFNC was safe and effective for the patients during awake craniotomy. TRIAL REGISTRATION: Chinese Clinical Trial Registry, CHiCTR1800016621. Date of Registration: 12 June 2018.