{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T03:02:36Z","timestamp":1779850956821,"version":"3.53.1"},"reference-count":38,"publisher":"American Dental Society of Anesthesiology (ADSA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>Obesity and sleep apnea syndrome (SAS) are significant risk factors for airway management, necessitating comprehensive preoperative evaluation, careful preparation, and adaptive strategies to prevent complications, such as hypoxemia, during sedation and general anesthesia. We report the use of intravenous moderate\/deep sedation to manage a patient with morbid obesity and severe SAS undergoing dental treatment using a high-flow nasal cannula (HFNC) system. The sedation was performed with a propofol infusion and was closely monitored using bispectral index (BIS) monitoring and capnography. Preparations for general anesthesia were made in case of severe apnea or hypoxemia. No significant airway obstruction or desaturation was observed perioperatively. The successful use of a HFNC system in this patient highlights the importance of tailored preoperative planning and meticulous airway management during dental sedations for patients with severe obesity and SAS.<\/jats:p>","DOI":"10.2344\/24-0051","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T15:26:23Z","timestamp":1772810783000},"page":"39-43","source":"Crossref","is-referenced-by-count":0,"title":["Intravenous Sedation of a Patient With Morbid Obesity and Severe Sleep Apnea Syndrome for Dental Treatment: A Case Report"],"prefix":"10.2344","volume":"73","author":[{"given":"Tomoya","family":"Onozawa","sequence":"first","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8586, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuri","family":"Hase","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8586, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukifumi","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8586, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanta","family":"Kido","sequence":"additional","affiliation":[{"name":"Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, 060-8586, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1191","reference":[{"issue":"5","key":"i1878-7177-73-1-39-b01","series-title":"Anesthesiology","first-page":"885","article-title":"Incidence and predictors of difficult and impossible mask ventilation","volume":"105","author":"Kheterpal S","year":"2006","unstructured":"Kheterpal S,\nHan R,\nTremper KK, et al. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology. 2006;105(5):885\u2013891."},{"issue":"6","key":"i1878-7177-73-1-39-b02","series-title":"Gastrointest Endosc","first-page":"1238","article-title":"Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures","volume":"74","author":"Wani S","year":"2011","unstructured":"Wani S,\nAzar R,\nHovis CE, et al. Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures. Gastrointest Endosc. 2011;74(6):1238\u20131247."},{"issue":"145","key":"i1878-7177-73-1-39-b03","series-title":"Eur Respir Rev","first-page":"170028","article-title":"Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device","volume":"26","author":"Ischaki E","year":"2017","unstructured":"Ischaki E,\nPantazopoulos I,\nZakynthinos S. Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device. Eur Respir Rev. 2017;26(145):170028."},{"key":"i1878-7177-73-1-39-b04","series-title":"J Clin Anesth","first-page":"111144","article-title":"The effectiveness of supplemental oxygen and high-flow nasal cannula therapy in patients with obstructive sleep apnea in different clinical settings: a systematic review and meta-analysis","volume":"88","author":"Ruan B","year":"2023","unstructured":"Ruan B,\nNagappa M,\nRashid-Kolvear M, et al. The effectiveness of supplemental oxygen and high-flow nasal cannula therapy in patients with obstructive sleep apnea in different clinical settings: a systematic review and meta-analysis. J Clin Anesth. 2023;88:111144."},{"issue":"5","key":"i1878-7177-73-1-39-b05","series-title":"Rev Port Pneumol","first-page":"217","article-title":"Clinical evidence on high flow oxygen therapy and active humidification in adults","volume":"19","author":"Gotera C","year":"2013","unstructured":"Gotera C,\nD\u00edaz Lobato S,\nPinto T,\nWinck JC. Clinical evidence on high flow oxygen therapy and active humidification in adults. Rev Port Pneumol. 2013;19(5):217\u2013227."},{"issue":"6","key":"i1878-7177-73-1-39-b06","series-title":"J Oral Maxillofac Surg","first-page":"1058","article-title":"A nasal high-flow system prevents hypoxia in dental patients under intravenous sedation","volume":"73","author":"Sago T","year":"2015","unstructured":"Sago T,\nHarano N,\nChogyoji Y,\nNunomaki M,\nShiiba S,\nWatanabe S. A nasal high-flow system prevents hypoxia in dental patients under intravenous sedation. J Oral Maxillofac Surg. 2015;73(6):1058\u20131064."},{"issue":"3","key":"i1878-7177-73-1-39-b07","series-title":"J Oral Maxillofac Surg","first-page":"539","article-title":"A nasal high-flow system prevents upper airway obstruction and hypoxia in pediatric dental patients under intravenous sedation","volume":"79","author":"Sago T","year":"2021","unstructured":"Sago T,\nWatanabe K,\nKawabata K,\nShiiba S,\nMaki K,\nWatanabe S. A nasal high-flow system prevents upper airway obstruction and hypoxia in pediatric dental patients under intravenous sedation. J Oral Maxillofac Surg. 2021;79(3):539\u2013545."},{"issue":"9","key":"i1878-7177-73-1-39-b08","series-title":"J Oral Maxillofac Surg","first-page":"1842","article-title":"Comparison of oxygen saturation between nasal high-flow oxygen and conventional nasal cannula in obese patients undergoing dental procedures with deep sedation: a randomized crossover trial","volume":"79","author":"Higuchi H","year":"2021","unstructured":"Higuchi H,\nTakaya-Ishida K,\nMiyake S, et al. Comparison of oxygen saturation between nasal high-flow oxygen and conventional nasal cannula in obese patients undergoing dental procedures with deep sedation: a randomized crossover trial. J Oral Maxillofac Surg. 2021;79(9):1842\u20131850."},{"key":"i1878-7177-73-1-39-b09","series-title":"Respir Med Case Rep","first-page":"118","article-title":"Use of high-flow nasal cannula in obese patients receiving colonoscopy under intravenous propofol sedation: a case series","volume":"23","author":"Lee CC","year":"2018","unstructured":"Lee CC,\nPerez O,\nFarooqi FI,\nAkella T,\nShaharyar S,\nElizee M. Use of high-flow nasal cannula in obese patients receiving colonoscopy under intravenous propofol sedation: a case series. Respir Med Case Rep. 2018;23:118\u2013121."},{"key":"i1878-7177-73-1-39-b10","series-title":"J Clin Anesth","first-page":"19","article-title":"High-flow versus standard nasal cannula in morbidly obese patients during colonoscopy: a prospective, randomized clinical trial","volume":"54","author":"Riccio CA","year":"2019","unstructured":"Riccio CA,\nSarmiento S,\nMinhajuddin A,\nNasir D,\nFox AA. High-flow versus standard nasal cannula in morbidly obese patients during colonoscopy: a prospective, randomized clinical trial. J Clin Anesth. 2019;54:19\u201324."},{"issue":"6","key":"i1878-7177-73-1-39-b11","series-title":"Br J Anaesth","first-page":"886","article-title":"Nasal high-flow therapy delivers low level positive airway pressure","volume":"103","author":"Parke R","year":"2009","unstructured":"Parke R,\nMcGuinness S,\nEccleston M. Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth. 2009;103(6):886\u2013890."},{"issue":"4","key":"i1878-7177-73-1-39-b12","series-title":"Aust Crit Care","first-page":"126","article-title":"High flow nasal oxygen generates positive airway pressure in adult volunteers","volume":"20","author":"Groves N","year":"2007","unstructured":"Groves N,\nTobin A. High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care. 2007;20(4):126\u2013131."},{"issue":"4","key":"i1878-7177-73-1-39-b13","series-title":"Tohoku J Exp Med","first-page":"373","article-title":"Management of exaggerated gag reflex using intravenous sedation in prosthodontic treatment","volume":"212","author":"Yoshida H","year":"2007","unstructured":"Yoshida H,\nAyuse T,\nIshizaka S,\nIshitobi S,\nNogami T,\nOi K. Management of exaggerated gag reflex using intravenous sedation in prosthodontic treatment. Tohoku J Exp Med. 2007;212(4):373\u2013378."},{"issue":"1","key":"i1878-7177-73-1-39-b14","series-title":"Anesthesiology","first-page":"63","article-title":"Evolution of changes in upper airway collapsibility during slow induction of anesthesia with propofol","volume":"111","author":"Hillman DR","year":"2009","unstructured":"Hillman DR,\nWalsh JH,\nMaddison KJ, et al. Evolution of changes in upper airway collapsibility during slow induction of anesthesia with propofol. Anesthesiology. 2009;111(1):63\u201371."},{"issue":"7","key":"i1878-7177-73-1-39-b15","series-title":"United European Gastroenterol J","first-page":"1037","article-title":"Dexmedetomidine vs propofol for gastrointestinal endoscopy: a meta-analysis","volume":"5","author":"Nishizawa T","year":"2017","unstructured":"Nishizawa T,\nSuzuki H,\nHosoe N,\nOgata H,\nKanai T,\nYahagi N. Dexmedetomidine vs propofol for gastrointestinal endoscopy: a meta-analysis. United European Gastroenterol J. 2017;5(7):1037\u20131045."},{"issue":"1","key":"i1878-7177-73-1-39-b16","series-title":"Br J Anaesth","first-page":"66","article-title":"Predictive performance of \u201cServin\u2019s formula\u201d during BIS-guided propofol-remifentanil target-controlled infusion in morbidly obese patients","volume":"98","author":"Albertin A","year":"2007","unstructured":"Albertin A,\nPoli D,\nLa Colla L, et al. Predictive performance of \u201cServin\u2019s formula\u201d during BIS-guided propofol-remifentanil target-controlled infusion in morbidly obese patients. Br J Anaesth. 2007;98(1):66\u201375."},{"issue":"4","key":"i1878-7177-73-1-39-b17","series-title":"Anesthesiology","first-page":"780","article-title":"Lateral position decreases collapsibility of the passive pharynx in patients with obstructive sleep apnea","volume":"97","author":"Isono S","year":"2002","unstructured":"Isono S,\nTanaka A,\nNishino T. Lateral position decreases collapsibility of the passive pharynx in patients with obstructive sleep apnea. Anesthesiology. 2002;97(4):780\u2013785."},{"issue":"1","key":"i1878-7177-73-1-39-b18","series-title":"J Intensive Care","first-page":"15","article-title":"High-flow nasal cannula oxygen therapy in adults","volume":"3","author":"Nishimura M.","year":"2015","unstructured":"Nishimura M. High-flow nasal cannula oxygen therapy in adults. J Intensive Care. 2015;3(1):15."},{"issue":"4","key":"i1878-7177-73-1-39-b19","series-title":"Br J Anaesth","first-page":"893","article-title":"Airway fires during use of high-flow nasal oxygen: a cause for concern","volume":"134","author":"Lyons C","year":"2025","unstructured":"Lyons C,\nJonsson Fagerlund M. Airway fires during use of high-flow nasal oxygen: a cause for concern. Br J Anaesth. 2025;134(4):893\u2013897."},{"issue":"5","key":"i1878-7177-73-1-39-b01","series-title":"Anesthesiology","first-page":"885","article-title":"Incidence and predictors of difficult and impossible mask ventilation","volume":"105","author":"Kheterpal S","year":"2006","unstructured":"Kheterpal S,\nHan R,\nTremper KK, et al. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology. 2006;105(5):885\u2013891."},{"issue":"6","key":"i1878-7177-73-1-39-b02","series-title":"Gastrointest Endosc","first-page":"1238","article-title":"Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures","volume":"74","author":"Wani S","year":"2011","unstructured":"Wani S,\nAzar R,\nHovis CE, et al. Obesity as a risk factor for sedation-related complications during propofol-mediated sedation for advanced endoscopic procedures. Gastrointest Endosc. 2011;74(6):1238\u20131247."},{"issue":"145","key":"i1878-7177-73-1-39-b03","series-title":"Eur Respir Rev","first-page":"170028","article-title":"Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device","volume":"26","author":"Ischaki E","year":"2017","unstructured":"Ischaki E,\nPantazopoulos I,\nZakynthinos S. Nasal high flow therapy: a novel treatment rather than a more expensive oxygen device. Eur Respir Rev. 2017;26(145):170028."},{"key":"i1878-7177-73-1-39-b04","series-title":"J Clin Anesth","first-page":"111144","article-title":"The effectiveness of supplemental oxygen and high-flow nasal cannula therapy in patients with obstructive sleep apnea in different clinical settings: a systematic review and meta-analysis","volume":"88","author":"Ruan B","year":"2023","unstructured":"Ruan B,\nNagappa M,\nRashid-Kolvear M, et al. The effectiveness of supplemental oxygen and high-flow nasal cannula therapy in patients with obstructive sleep apnea in different clinical settings: a systematic review and meta-analysis. J Clin Anesth. 2023;88:111144."},{"issue":"5","key":"i1878-7177-73-1-39-b05","series-title":"Rev Port Pneumol","first-page":"217","article-title":"Clinical evidence on high flow oxygen therapy and active humidification in adults","volume":"19","author":"Gotera C","year":"2013","unstructured":"Gotera C,\nD\u00edaz Lobato S,\nPinto T,\nWinck JC. Clinical evidence on high flow oxygen therapy and active humidification in adults. Rev Port Pneumol. 2013;19(5):217\u2013227."},{"issue":"6","key":"i1878-7177-73-1-39-b06","series-title":"J Oral Maxillofac Surg","first-page":"1058","article-title":"A nasal high-flow system prevents hypoxia in dental patients under intravenous sedation","volume":"73","author":"Sago T","year":"2015","unstructured":"Sago T,\nHarano N,\nChogyoji Y,\nNunomaki M,\nShiiba S,\nWatanabe S. A nasal high-flow system prevents hypoxia in dental patients under intravenous sedation. J Oral Maxillofac Surg. 2015;73(6):1058\u20131064."},{"issue":"3","key":"i1878-7177-73-1-39-b07","series-title":"J Oral Maxillofac Surg","first-page":"539","article-title":"A nasal high-flow system prevents upper airway obstruction and hypoxia in pediatric dental patients under intravenous sedation","volume":"79","author":"Sago T","year":"2021","unstructured":"Sago T,\nWatanabe K,\nKawabata K,\nShiiba S,\nMaki K,\nWatanabe S. A nasal high-flow system prevents upper airway obstruction and hypoxia in pediatric dental patients under intravenous sedation. J Oral Maxillofac Surg. 2021;79(3):539\u2013545."},{"issue":"9","key":"i1878-7177-73-1-39-b08","series-title":"J Oral Maxillofac Surg","first-page":"1842","article-title":"Comparison of oxygen saturation between nasal high-flow oxygen and conventional nasal cannula in obese patients undergoing dental procedures with deep sedation: a randomized crossover trial","volume":"79","author":"Higuchi H","year":"2021","unstructured":"Higuchi H,\nTakaya-Ishida K,\nMiyake S, et al. Comparison of oxygen saturation between nasal high-flow oxygen and conventional nasal cannula in obese patients undergoing dental procedures with deep sedation: a randomized crossover trial. J Oral Maxillofac Surg. 2021;79(9):1842\u20131850."},{"key":"i1878-7177-73-1-39-b09","series-title":"Respir Med Case Rep","first-page":"118","article-title":"Use of high-flow nasal cannula in obese patients receiving colonoscopy under intravenous propofol sedation: a case series","volume":"23","author":"Lee CC","year":"2018","unstructured":"Lee CC,\nPerez O,\nFarooqi FI,\nAkella T,\nShaharyar S,\nElizee M. Use of high-flow nasal cannula in obese patients receiving colonoscopy under intravenous propofol sedation: a case series. Respir Med Case Rep. 2018;23:118\u2013121."},{"key":"i1878-7177-73-1-39-b10","series-title":"J Clin Anesth","first-page":"19","article-title":"High-flow versus standard nasal cannula in morbidly obese patients during colonoscopy: a prospective, randomized clinical trial","volume":"54","author":"Riccio CA","year":"2019","unstructured":"Riccio CA,\nSarmiento S,\nMinhajuddin A,\nNasir D,\nFox AA. High-flow versus standard nasal cannula in morbidly obese patients during colonoscopy: a prospective, randomized clinical trial. J Clin Anesth. 2019;54:19\u201324."},{"issue":"6","key":"i1878-7177-73-1-39-b11","series-title":"Br J Anaesth","first-page":"886","article-title":"Nasal high-flow therapy delivers low level positive airway pressure","volume":"103","author":"Parke R","year":"2009","unstructured":"Parke R,\nMcGuinness S,\nEccleston M. Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth. 2009;103(6):886\u2013890."},{"issue":"4","key":"i1878-7177-73-1-39-b12","series-title":"Aust Crit Care","first-page":"126","article-title":"High flow nasal oxygen generates positive airway pressure in adult volunteers","volume":"20","author":"Groves N","year":"2007","unstructured":"Groves N,\nTobin A. High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care. 2007;20(4):126\u2013131."},{"issue":"4","key":"i1878-7177-73-1-39-b13","series-title":"Tohoku J Exp Med","first-page":"373","article-title":"Management of exaggerated gag reflex using intravenous sedation in prosthodontic treatment","volume":"212","author":"Yoshida H","year":"2007","unstructured":"Yoshida H,\nAyuse T,\nIshizaka S,\nIshitobi S,\nNogami T,\nOi K. Management of exaggerated gag reflex using intravenous sedation in prosthodontic treatment. Tohoku J Exp Med. 2007;212(4):373\u2013378."},{"issue":"1","key":"i1878-7177-73-1-39-b14","series-title":"Anesthesiology","first-page":"63","article-title":"Evolution of changes in upper airway collapsibility during slow induction of anesthesia with propofol","volume":"111","author":"Hillman DR","year":"2009","unstructured":"Hillman DR,\nWalsh JH,\nMaddison KJ, et al. Evolution of changes in upper airway collapsibility during slow induction of anesthesia with propofol. Anesthesiology. 2009;111(1):63\u201371."},{"issue":"7","key":"i1878-7177-73-1-39-b15","series-title":"United European Gastroenterol J","first-page":"1037","article-title":"Dexmedetomidine vs propofol for gastrointestinal endoscopy: a meta-analysis","volume":"5","author":"Nishizawa T","year":"2017","unstructured":"Nishizawa T,\nSuzuki H,\nHosoe N,\nOgata H,\nKanai T,\nYahagi N. Dexmedetomidine vs propofol for gastrointestinal endoscopy: a meta-analysis. United European Gastroenterol J. 2017;5(7):1037\u20131045."},{"issue":"1","key":"i1878-7177-73-1-39-b16","series-title":"Br J Anaesth","first-page":"66","article-title":"Predictive performance of \u201cServin\u2019s formula\u201d during BIS-guided propofol-remifentanil target-controlled infusion in morbidly obese patients","volume":"98","author":"Albertin A","year":"2007","unstructured":"Albertin A,\nPoli D,\nLa Colla L, et al. Predictive performance of \u201cServin\u2019s formula\u201d during BIS-guided propofol-remifentanil target-controlled infusion in morbidly obese patients. Br J Anaesth. 2007;98(1):66\u201375."},{"issue":"4","key":"i1878-7177-73-1-39-b17","series-title":"Anesthesiology","first-page":"780","article-title":"Lateral position decreases collapsibility of the passive pharynx in patients with obstructive sleep apnea","volume":"97","author":"Isono S","year":"2002","unstructured":"Isono S,\nTanaka A,\nNishino T. Lateral position decreases collapsibility of the passive pharynx in patients with obstructive sleep apnea. Anesthesiology. 2002;97(4):780\u2013785."},{"issue":"1","key":"i1878-7177-73-1-39-b18","series-title":"J Intensive Care","first-page":"15","article-title":"High-flow nasal cannula oxygen therapy in adults","volume":"3","author":"Nishimura M.","year":"2015","unstructured":"Nishimura M. High-flow nasal cannula oxygen therapy in adults. J Intensive Care. 2015;3(1):15."},{"issue":"4","key":"i1878-7177-73-1-39-b19","series-title":"Br J Anaesth","first-page":"893","article-title":"Airway fires during use of high-flow nasal oxygen: a cause for concern","volume":"134","author":"Lyons C","year":"2025","unstructured":"Lyons C,\nJonsson Fagerlund M. Airway fires during use of high-flow nasal oxygen: a cause for concern. 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