Usefulness of transnasal humidified rapid insufflation ventilatory exchange during rapid sequence induction for a patient with a hiatal hernia.

Abstract

A hiatal hernia can increase abdominal pressure, potentially leading to vomiting after the induction of general anesthesia. Therefore, rapid sequence induction is the preferred method for inducing general anesthesia in patients with hiatal hernias. The use of high-flow nasal cannula oxygen (HFNC) has become increasingly common to reduce the risk of oxygen desaturation during rapid induction. This report describes a case in which a hiatal hernia was successfully induced using HFNC. A 90-year-old woman with a history of reflux esophagitis was under medical management. Preoperative chest radiography revealed hiatal hernia. Anesthesia was induced after admission to the operating room and preoxygenation with HFNC. The oxygen flow was then increased to 70 L/min, and tracheal intubation was performed. SpO₂ remained at ≥99% during apnea for approximately 2 min, and no gastric reflux occurred. Rapid sequence induction combined with HFNC may be an effective option for patients with hiatal hernias who are at a high risk of gastric reflux during anesthetic induction.