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

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.