High-flow nasal oxygen as an adjunct for the safe removal of impacted metallic upper airway foreign bodies

Foreign body airway obstruction is considered an airway emergency and is a challenging clinical scenario for both the otolaryngologist and the anaesthetist. We present three cases of impacted upper airway metallic foreign bodies. Supra-glottic airways were obstructed and precarious. Apnoeic oxygenation utilizing high-flow nasal oxygen (HFNO), a form of tubeless anaesthetic, was used in all three cases, leading to the safe removal of the foreign bodies. Increased training, awareness and equipment availability to provide HFNO apnoeic oxygenation in the emergency setting for otolaryngology airway procedures will lead to better outcomes for patients and decreases the risk of a potential surgical airway.