High-Flow Nasal Oxygen versus Mechanical Ventilation Through a Laryngeal Mask During General Anesthesia…

Randomized trialAnesthesia and analgesia· Nov 2025

High-Flow Nasal Oxygen versus Mechanical Ventilation Through a Laryngeal Mask During General Anesthesia Without Muscle Paralysis: A Randomized Clinical Trial.

Luciano Frassanito, Domenico Luca Grieco, Francesco Vassalli … Gaetano Draisci

Airway ManagementRandomized trialTreatmentQ1IF 2.6

High-flow nasal oxygen noninferior to laryngeal mask for respiratory support without paralysis

High-Flow Nasal Oxygen versus Mechanical Ventilation Through a Laryngeal Mask During General Anesthesia Without Muscle Paralysis: A Randomized Clinical Trial.

Luciano Frassanito … Gaetano Draisci

Anesthesia and analgesia · Nov 2025 · Q1 in Anesthesiology

Background

Apneic oxygenation with high-flow nasal oxygen is a novel intraoperative respiratory support strategy for patients undergoing general anesthesia, but data about its clinical effects are scarce.

Methods

Were randomized to receive laryngeal mask ventilation (volume-controlled ventilation to obtain end-tidal carbon dioxide between 35 and 45 mm Hg, inhaled oxygen fraction to achieve peripheral oxygen saturation greater than 95%) or high-flow nasal oxygen (70 L per minute, inhaled oxygen fraction of 100%) for intraoperative respiratory support.

n = 180 patients

99%

Results

99%

respiratory support succeeded in nearly all patients, matching laryngeal mask

n = 180 patients

More results

Median [interquartile range] anesthesia duration was 25 [20-36] minutes in high-flow group and 32 minutes [27-44] in the laryngeal mask group.

Incidence of postoperative respiratory symptoms was significantly lower in high-flow versus laryngeal mask group (2% vs 19%, P < .001), while airway-related complications and postoperative dyspnea were not different.

More results

Intraoperative transcutaneous carbon dioxide was significantly higher in high-flow group, with 43% of patients showing values greater than 55 mm Hg.

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Conclusion · 1 of 2

High-flow nasal oxygen is noninferior to laryngeal mask ventilation for intraoperative respiratory support during 30-minute general anesthesia without muscle paralysis.

Conclusion · 2 of 2

The risk of hypercarbia warrants careful patient selection and monitoring.

High-Flow Nasal Oxygen versus Mechanical Ventilation Through a Laryngeal Mask During General Anesthesia Without Muscle Paralysis: A Randomized Clinical Trial.

High-Flow Nasal Oxygen versus Mechanical Ventilation Through a Laryngeal Mask During General Anesthesia Without Muscle Paralysis: A Randomized Clinical Trial.

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