Efficacy of HFNO during airway management of a COVID pneumonia patient with super morbid obesity undergoing emergency laparotomy

This case report describes the use of high flow nasal oxygen (HFNO) in a patient with morbid obesity (BMI = 90 kg/m(2)) who underwent emergency laparotomy under general anesthesia. This 54-year-old female patient with American Society of Anesthesia classification 4 E is known to have COVID pneumonia with Obstuctive Sleep Apnea. She was admitted in the ICU for 3 days and she was on Bilevel Positive Airway Pressure (BiPAP) alternating with HFNO to keep her SpO(2) 91%–92%, on FiO(2) 60%, and respiratory rate (RR) 40–45/min. The plan for airway management was rapid sequence intubation with preoxygenation using the HFNO. We here report this case to show the usefulness of HFNO, which adds a new dimension in airway management of similar cases.