Efficacy of High-flow Nasal Oxygenation During Induction of General Anesthesia in Parturient Living With Obesity: A Two-centre, Prospective, Randomized Clinical Trial

Anaesthesia . 2025;80:378-385. doi: 10.1111/anae.16492. Obesity during pregnancy is a growing global concern and is linked to higher rates of maternal and fetal complications. Physiological changes in pregnancy—such as reduced functional residual capacity and increased oxygen demand—are intensified by obesity, leading to a higher risk of rapid oxygen desaturation during the induction of general anesthesia. This, combined with increased aspiration risk, makes airway management in obese parturients particularly complex. Rapid sequence induction (RSI) is commonly used to reduce aspiration risk, but it can cause further oxygen desaturation. Although positive pressure ventilation can prevent this, that may increase the chance of gastric regurgitation. High-flow nasal oxygenation (HFNO) has shown benefits in prolonging safe apnea time in both non-obese and severely obese surgical patients, but its role in obese obstetric populations is not well defined.