Conventional Oxygen Therapy Versus Continuous Transnasal High Flow Oxygen Therapy for Head and Neck Diagnostic Panendoscopy Under General Anesthesia in Spontaneous Ventilation

This device allows the administration of a flow rate of up to 70 L/min while delivering heated gases. The benefit of Optiflow™ no longer needs to be demonstrated for certain intensive care patients. In the field of Anesthesia, the number of publications raised up since the increase in the non-hypoxemic apnea time during general anesthesia is never equaled by other methods.

What is known is that panendoscopy under general anesthesia in spontaneous ventilation is not unanimously accepted due to a higher risk regarding the time allowed for apnea, and laryngospasm complications. High-flow oxygen delivery provide a longer safe apnea time for patient safety. The aim of this investigation is to prove that high-flow oxygen therapy improves patient safety during general anesthesia for ENT panendoscopy. This should allow answering the question: shouldn't very high flow oxygenation be systematically offered for this procedure? Currently, there is no consensus as to the anaesthetic strategy for this procedure, if our hypothesis is verified; the Optiflow™ system could become de gold standard of the management of the upper airway during the ENT procedure.

Inclusion criteria

• Patients suffering from a head and neck cancer, most often tumor of the bucco-pharyngo-laryngeal cavities, having to carry out a diagnostic HN panendoscopy;
• Patient over 18 years of age;
• ASA < 4;
• BMI ≤ 45;
• Patient willing and able to provide written informed consent for the trial;;
• Patient affiliated with a health insurance system.

Exclusion criteria

• Patient with a contraindication to the Optiflow™ system as defined in the manufacturer's brochure;
• Patient with a tumor obstructing more than 80% of the glottic lumen;
• Patient with impossible intubation criteria:

• Mallampati 4 and mouth opening less than 20 mm
• Retrognathia
• Patient with:

• A known intracranial pathology;
• Documented pulmonary hypertension;
• Uncontrolled epilepsy;
• Uncontrolled heart rhythm disorder;
• Pulmonary pathology with hypoxemia: Spo2 <92% in ambient air;
• Patient at high risk of a full stomach evaluated by the anesthetist;
• ASA ≥ 4
• Morbid obesity with BMI> 45;
• Obstructive upper airway tumor with functional impact;
• Known contraindication to propofol or alfentanil;
• Panendoscopy procedure to be combined with an oesogastro-duodenal fibroscopy;
• Vulnerable persons as defined by articles 64 and 68 of Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices :

• In the case of incapacitated subjects who have not given, or have not refused to give, informed consent before the onset of their incapacity, a clinical investigation may be conducted only where, in addition to the conditions set out in Article 62(4)
• Pregnant or breast-feeding women who do not fall under the provisions of Article 66
• Adults subject to a legal protection order or unable to give their consent.