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Gallagher L, Todatry S, Oldenburg K, Misono S, Gray R. Endoscopic treatment of subglottic stenosis with flexible bronchoscopy via laryngeal mask airway. Laryngoscope 2024; 134:2672-2677. [PMID: 38095278 DOI: 10.1002/lary.31229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 05/09/2024]
Abstract
OBJECTIVE To evaluate the safety and efficacy of endoscopic treatment of subglottic stenosis with flexible bronchoscopy via laryngeal mask airway (LMA) approach. METHODS The records of all patients who underwent endoscopic surgery for subglottic stenosis (SGS) from November 2019 to January 2023 at an academic medical center were reviewed with attention to demographics, patient comorbidities, airway stenosis characteristics, operative time details, surgical complications, and post-operative course. All patients, >18 years old, with one or more surgeries for SGS using (LMA) for intraoperative airway management were included. Surgeries with suspension microlaryngoscopy were excluded. Patients with glottic stenosis or tracheotomy were excluded. RESULTS Thirty-five patients underwent 52 procedures meeting inclusion criteria. Mean age was 55 years (range 31-78, SD 13.3) and 33 patients (94%) were female. Mean BMI was 30.9 (range 18.4-60.5, SD 8.8). The most common etiology of stenosis was intubation injury in 17 patients (49%), followed by idiopathic in 13 patients (37%). Cotton-Meyer grade 3 (71-99% narrowing) was seen in 25 patients (71%). Mean anesthesia and surgical operative times were 75.9 min (SD 13.5 min) and 39.7 min (SD 11.0 min), respectively. Mean SpO2 nadir was 94.5% (SD 6.3%). No patients required intraoperative change to rigid laryngoscopy, intubation, or tracheotomy. There were no post-operative complications. Mean surgery-free interval was 12.2 months (SD 6.3). CONCLUSION Endoscopic treatment of subglottic stenosis with flexible bronchoscopy and spontaneous ventilation via LMA approach is a safe and effective option, especially in patients with limitations for rigid laryngoscopy and elevated BMI. LEVEL OF EVIDENCE Level Four (case series) Laryngoscope, 134:2672-2677, 2024.
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Affiliation(s)
- Liam Gallagher
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Soorya Todatry
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Kirsi Oldenburg
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Stephanie Misono
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Raluca Gray
- Department of Otolaryngology-Head & Neck Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
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Rigal T, Baudouin R, Circiu M, Couineau F, Lechien J, Crevier‐Buchman L, Le Guen M, Hans S. Laryngeal microsurgery under Transnasal Humidified Rapid Insufflation Ventilatory Exchange. OTO Open 2024; 8:e125. [PMID: 38863485 PMCID: PMC11165682 DOI: 10.1002/oto2.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/27/2024] [Indexed: 06/13/2024] Open
Abstract
Objective Since 2015, Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) has been used in general anesthesia for preoxygenation or difficult exposure airway management. Its use offers new opportunities in laryngology. THRIVE increases apnea time and frees the access to the upper airway. However, its use may be less stable than orotracheal intubation. The main objective of this work was to evaluate the feasibility of laryngeal microsurgery under THRIVE including using Laser. Study Design Retrospective. Setting A total of N = 99 patients with laryngeal microsurgery (with or without CO2 laser) under THRIVE were included successively from January 1, 2020 to January 30, 2022. Method Medical history, comorbidities, clinical and surgical data were extracted and analyzed. Two groups were constituted regarding the "success" (use of THRIVE along all the procedure) or the "failure" (need for an endotracheal tube) of the use of THRIVE during the procedure. Results A failure occurred in N = 15/99 patients (15.2%) mainly due to refractory hypoxia. The odd ratios (OR) for THRIVE failure were: OR = 6.6 [2.9-35] for overweight (BMI >25 kg/m2); OR = 3.8 [1.7-18.7] for ASA score >2; OR = 4.7 [2.3-24.7] for the use of CO2 laser. Elderly patients and patients with pulmonary pathology were not statistically at greater risk of THRIVE failure. No adverse event was described. Conclusion This work confirms the feasibility of laryngeal microsurgery under THRIVE, including with CO2 laser. Overweight, ASA >2 and lower fraction of inspired oxygen during CO2 laser use increased the risk for orotracheal intubation.
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Affiliation(s)
- Tiffany Rigal
- Department of Otolaryngology–Head and Neck SurgeryFoch HospitalSuresnesFrance
- School of Medicine, UFR Simone VeilUniversité Versailles Saint‐Quentin‐en‐Yvelines (Paris Saclay University)Montigny‐le‐BretonneuxFrance
| | - Robin Baudouin
- Department of Otolaryngology–Head and Neck SurgeryFoch HospitalSuresnesFrance
- School of Medicine, UFR Simone VeilUniversité Versailles Saint‐Quentin‐en‐Yvelines (Paris Saclay University)Montigny‐le‐BretonneuxFrance
| | - Marta Circiu
- Department of Otolaryngology–Head and Neck SurgeryFoch HospitalSuresnesFrance
- School of Medicine, UFR Simone VeilUniversité Versailles Saint‐Quentin‐en‐Yvelines (Paris Saclay University)Montigny‐le‐BretonneuxFrance
| | - Florent Couineau
- Department of Otolaryngology–Head and Neck SurgeryFoch HospitalSuresnesFrance
- School of Medicine, UFR Simone VeilUniversité Versailles Saint‐Quentin‐en‐Yvelines (Paris Saclay University)Montigny‐le‐BretonneuxFrance
| | - Jérôme Lechien
- Department of Otolaryngology–Head and Neck SurgeryFoch HospitalSuresnesFrance
- School of Medicine, UFR Simone VeilUniversité Versailles Saint‐Quentin‐en‐Yvelines (Paris Saclay University)Montigny‐le‐BretonneuxFrance
- Department of OtolaryngologyElsan Polyclinic of PoitiersPoitiersFrance
- Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research, Institute for Health Sciences and TechnologyUniversity of Mons (UMons)MonsBelgium
- Division of Laryngology and Broncho‐EsophagologyEpiCURA HospitalBaudourBelgium
| | - Lise Crevier‐Buchman
- Department of Otolaryngology–Head and Neck SurgeryFoch HospitalSuresnesFrance
- School of Medicine, UFR Simone VeilUniversité Versailles Saint‐Quentin‐en‐Yvelines (Paris Saclay University)Montigny‐le‐BretonneuxFrance
- Phonetics and Phonology Laboratory (UMR 7018 CNRS, Université Sorbonne Nouvelle/Paris 3)ParisFrance
| | - Morgan Le Guen
- School of Medicine, UFR Simone VeilUniversité Versailles Saint‐Quentin‐en‐Yvelines (Paris Saclay University)Montigny‐le‐BretonneuxFrance
- Department of Anesthesiology, Foch HospitalSchool of MedicineSuresnesFrance
- Simulation CenterFoch HospitalSuresnesFrance
| | - Stéphane Hans
- Department of Otolaryngology–Head and Neck SurgeryFoch HospitalSuresnesFrance
- School of Medicine, UFR Simone VeilUniversité Versailles Saint‐Quentin‐en‐Yvelines (Paris Saclay University)Montigny‐le‐BretonneuxFrance
- Phonetics and Phonology Laboratory (UMR 7018 CNRS, Université Sorbonne Nouvelle/Paris 3)ParisFrance
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Ananthapadmanabhan S, Kudpaje A, Raju D, Smith M, Riffat F, Novakovic D, Stokan M, Palme CE. Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) and its Utility in Otolaryngology, Head and Neck Surgery: A Literature Review. Indian J Otolaryngol Head Neck Surg 2024; 76:1921-1930. [PMID: 38566676 PMCID: PMC10982204 DOI: 10.1007/s12070-023-04445-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/13/2023] [Indexed: 04/04/2024] Open
Abstract
High-flow nasal oxygen (HFNO) therapy is extensively used in critical care units for spontaneously breathing patients. Trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) is a method of apnoeic oxygenation with continuous nasal delivery of warmed, humidified oxygen at high-flow rates up to 70L/min. THRIVE extends the apnoeic window before desaturation occurs so that tubeless anaesthesia is possible. The advent of THRIVE has had a monumental impact on anaesthetic practice, with a diverse range of clinical applications and it has been incorporated into difficult airway guidelines. THRIVE has many applications in otolaryngology and head and neck surgery. It is used as a pre-oxygenation tool during induction in both anticipated and unanticipated difficult airway scenarios and as a method of oxygenation for tubeless anaesthesia in elective laryngotracheal and hypopharyngeal surgeries and during emergence from anaesthesia. In this scoping review of the literature, we aim to provide an overview on the utility of THRIVE in otolaryngology, including the underlying physiologic principles, current indications and limitations, and its feasibility and safety in different surgical contexts and specific population groups.
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Affiliation(s)
| | - Akshay Kudpaje
- Department of Head and Neck Surgical Oncology, Cytecare Cancer Hospital, Bangalore, Karnataka India
| | - Dinesh Raju
- Department of Anaesthesia, Critical Care, and Pain, Cytecare Cancer Hospital, Bangalore, Karnataka India
| | - Mark Smith
- Department of Otolaryngology, Westmead Hospital, Westmead, NSW 2145 Australia
- Chris O’Brien Lifehouse, Camperdown, NSW Australia
| | - Faruque Riffat
- Department of Otolaryngology, Westmead Hospital, Westmead, NSW 2145 Australia
- Chris O’Brien Lifehouse, Camperdown, NSW Australia
| | - Daniel Novakovic
- Chris O’Brien Lifehouse, Camperdown, NSW Australia
- The Canterbury Hospital, Campsie, NSW Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW Australia
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Yang ZM, Loh TH, Ross J, Dalal K, Meiler SE, Postma GN. Transnasal Humidified Rapid Insufflation Ventilatory Exchange in Endoscopic Esophageal Surgery. Ann Otol Rhinol Laryngol 2024; 133:325-329. [PMID: 38050852 PMCID: PMC10865761 DOI: 10.1177/00034894231216273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVES Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) describes apneic oxygenation using humidified high flow nasal-cannula oxygen. Although it has been described as a sole mode of oxygenation in endoscopic laryngotracheal surgery, its use in endoscopic esophageal surgery under general anesthesia with neuromuscular paralysis has not previously been described. The objective of this study is to assess the safety and efficacy of THRIVE in esophagology. METHODS We conducted a retrospective review of adult patients undergoing esophageal procedures under general anesthesia who were oxygenated using THRIVE at two academic institutions. Demographic, clinical, and anesthesiologic data were collected and analyzed. RESULTS 14 cases performed from March 2021 to March 2022 met inclusion criteria. 13/14 (92.9%) of patients were able to maintain oxygenation throughout the entirety of their procedure. The mean apneic time was 17.9 minutes with a maximum of 32 minutes. One patient required "rescue" intubation due to failure to maintain oxygenation. Excluding the sole THRIVE failure, the median SpO2 at the conclusion of surgery was 99% (range 94-100%). A linear regression model yielded an increase in EtCO2 of 0.95 mmHg/min or 0.127 kPa/min. SpO2 was negatively associated with both tobacco pack-year smoking history (R2 = 0.343, P = .014) and BMI (R2 = 0.238, P = .038). CONCLUSION THRIVE is a feasible, safe, and efficacious means of apneic oxygenation for patients undergoing esophageal endoscopic surgery under general anesthesia with neuromuscular paralysis, which may be particularly beneficial in patients with airway stenosis, as post-intubation changes can have severe clinical implications for this patient population. Obese patients and tobacco smokers may be at increased risk of oxygen desaturation when using THRIVE.
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Affiliation(s)
- Zao M. Yang
- Department of Otolaryngology, Head & Neck Surgery, UT Health San Antonio, San Antonio, TX, USA
- Department of Otolaryngology, Head & Neck Surgery, Augusta University Medical College of Georgia, Augusta, GA, USA
| | - Tuan-Hsing Loh
- Department of Anesthesiology, UT Health San Antonio, San Antonio, TX, USA
| | - Justin Ross
- Department of Otolaryngology, Head & Neck Surgery, Augusta University Medical College of Georgia, Augusta, GA, USA
| | - Kajal Dalal
- Department of Otolaryngology, Head & Neck Surgery, UT Health San Antonio, San Antonio, TX, USA
| | - Steffen E. Meiler
- Department of Anesthesiology, Augusta University Medical College of Georgia, Augusta, GA, USA
| | - Gregory N. Postma
- Department of Otolaryngology, Head & Neck Surgery, Augusta University Medical College of Georgia, Augusta, GA, USA
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Sharma V, Atluri H. Unveiling the Success of Awake Insertion of Supraglottic Airway Device for Ventilation in the Bronchoscopic Management of Tracheal Stenosis. Cureus 2024; 16:e54703. [PMID: 38524051 PMCID: PMC10960592 DOI: 10.7759/cureus.54703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/26/2024] Open
Abstract
Tracheal and subglottic stenoses are inflammatory conditions that can arise from a variety of potential etiologies, most commonly as a result of iatrogenic airway injury due to endotracheal intubation. Significant stenosis requires management by endoscopy or surgical resection. We describe a case of recurrent subglottic cuff stenosis with an episode of sudden desaturation in a 25-year-old female. The management involved balloon dilatation, laser ablation, and topical mitomycin C application through a flexible fiberoptic bronchoscope. Ensuring safe gas exchange during bronchoscopy was a priority, and this was achieved by maintaining ventilation with a supraglottic airway device, which was inserted in an awake patient after adequate tropicalization of the oral cavity. The intervention successfully helped in the management of stenosis and also addressed the complication of sudden complete airway collapse due to sedation.
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Affiliation(s)
- Vipul Sharma
- Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Center, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Harika Atluri
- Anesthesiology, Dr. D. Y. Patil Medical College, Hospital and Research Center, Dr. D. Y. Patil Vidyapeeth, Pune, IND
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Vaithialingam B, Bansal S, Muthuchellappan R, Thirthalli J, Chakrabarti D, Venkatapura RJ. Comparison of hands-free Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) with conventional facemask ventilation technique for oxygenation in patients undergoing electroconvulsive therapy - A cross over study. Asian J Psychiatr 2023; 88:103734. [PMID: 37619421 DOI: 10.1016/j.ajp.2023.103734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES Modified ECT is routinely conducted using face mask (FM) and bag ventilation technique. Trans-nasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is a novel hands-free insufflation technique that provides oxygenation and prolongs apnoea time. There is limited literature comparing the two techniques. Primary objective of this study was to compare oxygen desaturation between THRIVE and FM techniques during ECT while secondary objective was to compare hemodynamics and complications. METHODS Patients aged 18-50 years undergoing 3rd-5th ECT treatments were enrolled. First ECT was with FM technique followed by THRIVE (with LUBO collar) in the next ECT. Except for the oxygenation technique, the protocol for ECT administration was similar with both techniques. SpO2 values were recorded every minute for 10 min while hemodynamic parameters were measured at 2 min and 5 min following administration of electrical stimulus. Any drop in SpO2 below 92 % was considered as a desaturation event. RESULTS A total of 201 patients underwent ECTs, one each with FM and THRIVE technique. Median age of patients was 28 years. There was no difference in SpO2 between the techniques (main effect P = 0.324, interaction P = 0.14). Only one patient had desaturation with THRIVE requiring intervention with FM. None of the patients had any airway complications in terms of nasal injury, hoarseness, or pneumothorax with THRIVE. CONCLUSION THRIVE is a safe alternative option for hands-free oxygenation while administering ECT. However, considering patient safety, an anaesthesiologist competent in airway management must be readily available.
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Affiliation(s)
| | - Sonia Bansal
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, 560029, India
| | - Radhakrishnan Muthuchellappan
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru 560029, India
| | - Dhritiman Chakrabarti
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, 560029, India
| | - Ramesh J Venkatapura
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, 560029, India.
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Chan KC, Yang TX, Khu KF, So CV. High-flow Nasal Cannula versus Conventional Ventilation in Laryngeal Surgery: A Systematic Review and Meta-analysis. Cureus 2023; 15:e38611. [PMID: 37284366 PMCID: PMC10239706 DOI: 10.7759/cureus.38611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
High-flow nasal cannula (HFNC) is an emerging option for maintaining oxygenation in patients undergoing laryngeal surgery, as an alternative to traditional tracheal ventilation and jet ventilation (JV). However, the data on its safety and efficacy is sparse. This study aims to aggregate the current data and compares the use of HFNC with tracheal intubation and jet ventilation in adult patients undergoing laryngeal surgery. We searched PubMed, MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online), Embase (Excerpta Medica Database), Google Scholar, Cochrane Library, and Web of Science. Both observational studies and prospective comparative studies were included. Risk of bias was appraised with the Cochrane Collaboration Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) or RoB2 tools and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for case series. Data were extracted and tabulated as a systematic review. Summary statistics were performed. Meta-analyses and trial sequential analyses of the comparative studies were performed. Forty-three studies (14 HFNC, 22 JV, and seven comparative studies) with 8064 patients were included. In the meta-analysis of comparative studies, the duration of surgery was significantly reduced in the THRIVE (Transnasal Humidified Rapid-Insufflation Ventilatory Exchange) group, but the number of desaturations, need for rescue intervention, and peak end-tidal CO2 were significantly increased compared to the conventional ventilation group. The evidence was of moderate certainty and there was no evidence of publication bias. In conclusion, HFNC may be as effective as tracheal intubation in oxygenation during laryngeal surgery in selected adult patients and reduces the duration of surgery but conventional ventilation with tracheal intubation may be safer. The safety of JV was comparable to HFNC.
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Affiliation(s)
- Kai Chun Chan
- Department of Anaesthesiology and Operating Theatre Services, Queen Elizabeth Hospital, Kowloon, HKG
| | - Timothy Xianyi Yang
- Department of Anaesthesiology and Operating Theatre Services, Queen Elizabeth Hospital, Kowloon, HKG
| | - Kin Fai Khu
- Department of Anaesthesiology, Princess Margaret Hospital, Kowloon, HKG
| | - Ching Vincent So
- Department of Anaesthesiology, Queen Mary Hospital, Hong Kong Island, HKG
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Conti C, Mauvais O, Samain E, Tavernier L, Floury SP, Besch G, Ferreira D. Comparison of the efficacy of high-flow nasal oxygenation and spontaneous breathing with face mask ventilation during panendoscopy. Br J Anaesth 2023; 130:e474-e476. [PMID: 37080868 DOI: 10.1016/j.bja.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/04/2023] [Accepted: 03/13/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
- Clément Conti
- Département d'Anesthésie Réanimation Chirurgicale, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Olivier Mauvais
- Département d'ORL, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Emmanuel Samain
- Département d'Anesthésie Réanimation Chirurgicale, Centre Hospitalier Universitaire de Besançon, Besançon, France; EA3920, University of Franche Comté, Besançon, France
| | - Laurent Tavernier
- Département d'ORL, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Sébastien Pili Floury
- Département d'Anesthésie Réanimation Chirurgicale, Centre Hospitalier Universitaire de Besançon, Besançon, France; EA3920, University of Franche Comté, Besançon, France
| | - Guillaume Besch
- Département d'Anesthésie Réanimation Chirurgicale, Centre Hospitalier Universitaire de Besançon, Besançon, France; EA3920, University of Franche Comté, Besançon, France
| | - David Ferreira
- Département d'Anesthésie Réanimation Chirurgicale, Centre Hospitalier Universitaire de Besançon, Besançon, France; Laboratoire de Recherches Intégratives en Neurosciences et Psychologie Cognitive (LINC), Université de Franche-Comté, Besançon, France.
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Liu J, Xiong L, Li H, Du M, Ru X, Xu Y. Comparison of the application of high-flow nasal oxygen with two different oxygen concentrations in infant and child laryngotracheal surgery. Front Med (Lausanne) 2023; 10:1169345. [PMID: 37089587 PMCID: PMC10113539 DOI: 10.3389/fmed.2023.1169345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/20/2023] [Indexed: 04/07/2023] Open
Abstract
BackgroundThis study aimed to compare the use of the STRIVE Hi technique with 70 and 100% oxygen concentrations in children with 1st or 2nd degree laryngeal obstruction undergoing suspension laryngoscopic surgery.MethodsChildren aged 1 month to 6 years scheduled for suspension laryngoscopic surgery with spontaneous respiration were randomly divided into the 70% oxygen concentration group (HFNO70% group) and the 100% oxygen concentration group (HFNO100% group). The data recorded for all the patients included age and sex, comorbidities, preoperative physiological status, methods of induction and maintenance of anesthesia, course of the disease and surgical options, and duration of operation. The primary endpoint was the lowest oxygen saturations during the surgery. The secondary endpoints included the partial pressure of oxygen PaO2, the arterial pressure of carbon dioxide PaCO2, the peak transcutaneous carbon dioxide PtcCO2, and the incidence of desaturation (defined as SpO2 < 90%) or hypercarbia (PtcCO2 > 65 mmHg).ResultsA total of 80 children with 1st or 2nd degree laryngeal obstruction were included in the analysis. The median [IQR (range)] duration of spontaneous ventilation using STRIVE Hi was 52.5 [40–60 (30–170)]min and 62.5 [45–81 (20–200)]min in the HFNO 70% and HFNO 100% groups, respectively (p = 0.99); the lowest oxygen saturation recorded during the operation was 97.8 ± 2.1% and 96.8 ± 2.5%, respectively (p = 0.053); the mean PaO2 at the end of surgery was 184.6 ± 56.3 mmHg and 315.2 ± 101.3 mmHg, respectively (p < 0.001); and the peak transcutaneous CO2 was 58.0 ± 13.0 mmHg and 60.4 ± 10.9 mmHg, respectively (p = 0.373), despite a long operation time.ConclusionSTRIVE Hi had a positive effect on children undergoing tubeless laryngeal surgery with spontaneous ventilation, and for children with 1st or 2nd degree laryngeal obstruction, there was no significant difference in maintaining the intraoperative oxygenation between the 70 and 100% oxygen concentration groups. The 100% oxygen concentration group showed significant hyperoxia, which has been proven to be associated with multiple organ damage. Using a relatively lower oxygen concentration of 70% can effectively reduce the hazards associated with hyperoxia compared to 100% oxygen concentration.Clinical trial registration[www.chictr.org.cn], identifier [CHICTR2200064500].
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Affiliation(s)
- Jianxia Liu
- Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Chongqing Key Laboratory of pediatrics, Chongqing, China
| | - Ling Xiong
- Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Chongqing Key Laboratory of pediatrics, Chongqing, China
| | - Haisu Li
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Chongqing Key Laboratory of pediatrics, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Critical Disorders, Chongqing, China
| | - Min Du
- Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Chongqing Key Laboratory of pediatrics, Chongqing, China
| | - Xue Ru
- Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Chongqing Key Laboratory of pediatrics, Chongqing, China
| | - Ying Xu
- Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- Chongqing Key Laboratory of pediatrics, Chongqing, China
- *Correspondence: Ying Xu,
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Min SH, Seo JH. Tube or tubeless: an anesthetic strategy for upper airway surgery. Anesth Pain Med (Seoul) 2023; 18:123-131. [PMID: 37183280 PMCID: PMC10183614 DOI: 10.17085/apm.23014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/15/2023] [Indexed: 05/16/2023] Open
Abstract
Since the patient's airway is shared between an anesthesiologist and a surgeon, airway management during upper airway surgery can be challenging. Beyond the conventional method of general anesthesia, high-flow nasal oxygenation (HFNO) has recently been used as a key technique for tubeless anesthesia. HFNO provides humidified, heated oxygen up to 70 L/min, which promises improved oxygenation and ventilation, allowing for prolonged apneic oxygenation. In previous physiological and clinical studies, HFNO has been demonstrated that tubeless anesthesia safely provide an uninterrupted surgical field during laryngeal surgeries. Although tubeless anesthesia remains uncommon, it can be a good alternative to conventional anesthesia if an anesthesiologist and a surgeon select appropriate patients together with sufficient experience. A safe strategy for tubeless anesthesia, along with appropriate backup plans, including endotracheal intubation and high-frequency jet ventilation, should be considered for upper airway surgery.
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Affiliation(s)
- Se-Hee Min
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Jeong Hwa Seo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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Courbon C. Spontaneous Ventilation With High-Flow Nasal Oxygen for Elective Suspension Microlaryngoscopy. OTO Open 2023; 7:e54. [PMID: 37220496 PMCID: PMC10200014 DOI: 10.1002/oto2.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 05/25/2023] Open
Abstract
Objective Spontaneous ventilation under intravenous anesthesia allows the surgeon to work without interruption or obstruction of the operating field during suspension microlaryngoscopy (SML). High-flow nasal oxygen therapy (HFNO) is increasingly used in anesthesia. We hypothesized that its use during SML would increase patient safety even in situations where the airway is compromised by tumor or stenosis. Study Design Retrospective observational study. Setting University Hospital of Lausanne, Switzerland. Methods Adults patients who were scheduled for elective microlaryngeal surgery and managed with HFNO in spontaneous ventilation under general anesthesia between October 2020 and December 2021. Results Twenty-seven patients for a total of 32 surgical procedures were performed under HFNO with spontaneous ventilation. Seventy-five percent of the patients had respiratory symptoms. Twelve patients (42.9%) were planned for the treatment of subglottic or tracheal stenosis and 5 patients were managed for vocal cord cancer (18.5%). Out of 32 surgeries, 4 cases of saturation < 92% occurred, 3 of them during the decrease of the fraction of inspired oxygen to 30% for the use of the laser. In 3 cases, the patients were intubated to correct the hypoxemia. Conclusion Spontaneous respiration using intravenous anesthesia and high-flow nasal oxygen is a modern technique that increases patient safety while allowing the surgeon to work without interruption or imputation of the operative field during SML. This approach is particularly promising for the management of airways compromised by tumors or laryngotracheal stenosis.
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Affiliation(s)
- Cecile Courbon
- Department of AnesthesiaUniversity Hospital of LausanneLausanneSwitzerland
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12
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Mangahas AM, Talugula S, Husain IA. Anesthesia considerations during management of airway stenosis: A systematic review. Am J Otolaryngol 2023; 44:103767. [PMID: 36586317 DOI: 10.1016/j.amjoto.2022.103767] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the efficacy of ventilatory techniques by evaluating prevalence of technique failure and intraoperative hypoxia during endoscopic management of airway stenosis. DATA SOURCES A systematic review was conducted using PubMed and Embase for anesthesia techniques in endoscopic management of airway stenosis. REVIEW METHODS The primary outcome measured was reports of partial and complete technique failure. The secondary outcome measured was intraoperative hypoxia. RESULTS We identified 7704 abstracts with 17 meeting criteria for analysis. The reported partial and complete ventilatory technique failures were: 0 % Evone Flow-Controlled Ventilation with Tritube endotracheal tube, 0 % laryngeal mask airway, 0 % nonocclusive balloon dilator, 4.76 % spontaneous respiration using intravenous anesthesia and Hi-flow nasal oxygen, and 30.24 % jet ventilation. The reported rate of intraoperative hypoxia was: 0 % Evone Flow-Controlled Ventilation with Tritube endotracheal tube, 0 % spontaneous respiration using intravenous anesthesia and Hi-flow nasal oxygen, 2.18 % jet ventilation, 3.57 % laryngeal mask airway, and 5 % nonocclusive balloon dilator. CONCLUSION Evone Flow-Controlled Ventilation with Tritube endotracheal tube had the lowest risk of technique failure and intraoperative hypoxia. Nonocclusive balloon dilator and laryngeal mask airway were also favorable techniques for ventilation. Jet ventilation showed a lower rate of intraoperative hypoxia, but a higher rate of failure. Newer techniques, such as Evone Flow-Controlled Ventilation with Tritube, nonocclusive balloon dilator and spontaneous respiration using intravenous anesthesia and Hi-flow nasal oxygen, may offer promise compared to older techniques like jet ventilation; however, larger studies with more uniform data are needed to determine their efficacy.
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Affiliation(s)
- Angelica M Mangahas
- University of Illinois College of Medicine - Rockford, 1601 Parkview Ave, Rockford, IL 61107, United States of America.
| | - Snehitha Talugula
- University of Illinois College of Medicine - Chicago, 1853 W Polk St, Chicago, IL 60613, United States of America
| | - Inna A Husain
- Community Hospital, Otolaryngology, 901 MacArthur Blvd, Munster, IN 46321, United States of America
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Ran L, Huang G, Yao Y, Wu Y, Zhang C, Wang Y, Yu C. Efficacy of high-flow nasal oxygenation compared with laryngeal mask airway in children undergoing ambulatory oral surgery under deep sedation: A randomized controlled non-inferiority trial. Front Med (Lausanne) 2022; 9:1001213. [PMID: 36530879 PMCID: PMC9755657 DOI: 10.3389/fmed.2022.1001213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/04/2022] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND High-flow nasal oxygenation (HFNO) has been suggested as an alternative oxygenation method during procedural sedation. This randomized, non-inferiority trial evaluated the safety and efficacy of HFNO compared with laryngeal mask airway (LMA) in pediatric ambulatory oral surgery under deep sedation. METHODS In total, 120 children aged 2-7 years (weight: 10-30 kg) were equally assigned into two groups, namely, HFNO with propofol total intravenous anesthesia infusion (HFNO-IV) or LMA with propofol total intravenous anesthesia infusion (LMA-IV). The primary objective was to monitor carbon dioxide (CO2) accumulation during perioperative surgery. Secondary objectives included monitoring transcutaneous oxygen saturation, grade exposure to the surgical field, perioperative adverse events, or other events. The predefined non-inferiority margin was 7 mmHg. During the COVID-19 pandemic, a novel WeChat applet was implemented to gather follow-up data after discharge. RESULTS Non-inferiority could be declared for HFNO relative to LMA (mean difference in transcutaneous CO2 (TcCO2) = -1.4 mmHg, 95% CI: -2.9, 0.1 mmHg; P > 0.05). The pre-surgical TcCO2 of the HFNO-IV group (45.4 ± 4.5 mmHg) was similar to that of the LMA-IV group (44.0 ± 3.5 mmHg), within the clinically acceptable normal range. All the children maintained SpO2 levels of >97%. The surgical field exposure score of the HFNO group was significantly better than that of the LMA group. There was no significant difference between the two groups regarding risk or adverse events. CONCLUSION HFNO was not inferior to LMA for maintaining oxygenation and ventilation in patients undergoing pediatric ambulatory oral surgery under deep sedation under strict isolation from the oral cavity to the upper airway.
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Affiliation(s)
- Longkuan Ran
- Department of Anesthesiology, Stomatology Hospital Affiliated Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Guijin Huang
- Department of Anesthesiology, Stomatology Hospital Affiliated Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Ying Yao
- Department of Anesthesiology, Stomatology Hospital Affiliated Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yujia Wu
- Department of Anesthesiology, Stomatology Hospital Affiliated Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Chao Zhang
- Department of Anesthesiology, Stomatology Hospital Affiliated Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Yan Wang
- Department of Anesthesiology, Stomatology Hospital Affiliated Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Cong Yu
- Department of Anesthesiology, Stomatology Hospital Affiliated Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
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14
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Min SH, Yoon H, Huh G, Kwon SK, Seo JH, Cho YJ. Efficacy of high-flow nasal oxygenation compared with tracheal intubation for oxygenation during laryngeal microsurgery: a randomised non-inferiority study. Br J Anaesth 2021; 128:207-213. [PMID: 34688473 DOI: 10.1016/j.bja.2021.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Oxygenation via a high-flow nasal cannula (HFNC) can be an alternative to tracheal intubation during short apnoeic procedures. This randomised, non-inferiority study assessed the efficacy of HFNC compared with tracheal intubation in laryngeal microsurgery. METHODS Patients (≥20 yr old) undergoing laryngeal microsurgery under general anaesthesia and neuromuscular blockade were randomised to either the HFNC or tracheal intubation groups. The primary endpoint was lowest pulse oxygen saturation (SpO2) during the first 30 min of surgery. Secondary endpoints included incidence of desaturation (SpO2 <95%), hypercarbia (transcutaneous carbon dioxide [CO2] ≥8.7 kPa), and rescue intervention. RESULTS Amongst 130 patients randomised, 118 were included in the analysis. The lowest SpO2 was 100 (98-100)% in the HFNC group (n=56) and 100 (100-100)% in the tracheal intubation group (n=62), with a mean difference of -1.4% (95% confidence interval: -2.4% and -0.3%), failing to confirm non-inferiority with a non-inferiority margin of 2%. The peak transcutaneous CO2 and end-tidal CO2 at the end of surgery were higher in the HFNC group compared with the tracheal intubation group. Incidences of desaturation, hypercarbia, and rescue intervention were more frequent in patients receiving HFNC compared with tracheal intubation. CONCLUSIONS HFNC oxygenation was not non-inferior to tracheal intubation for maintaining oxygen saturation during laryngeal microsurgery. Considering more frequent desaturation, hypercarbia, and requirement for rescue intervention compared with tracheal intubation, HFNC should be used with cautious monitoring even for short duration airway surgery. CLINICAL TRIAL REGISTRATION NCT03629353.
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Affiliation(s)
- Se-Hee Min
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Anaesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Heechul Yoon
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gene Huh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong K Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hwa Seo
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youn J Cho
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Youssef DL, Paddle P. Tubeless Anesthesia in Subglottic Stenosis: Comparative Review of Apneic Low-Flow Oxygenation With THRIVE. Laryngoscope 2021; 132:1231-1236. [PMID: 34585757 DOI: 10.1002/lary.29885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/16/2021] [Accepted: 09/07/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Managing the shared airway in subglottic stenosis presents a unique challenge. Tubeless anesthesia with apneic oxygenation is increasingly being adopted as it overcomes the limitations of access to and visualization of the narrowed subglottis. Low-flow oxygenation (LFO) and transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) are two delivery techniques. We sought to compare their utility in this patient cohort. STUDY DESIGN Retrospective cohort study. METHODS Thirty-five cases of endoscopic debridement of subglottic stenosis were retrospectively studied. Operative technique was consistent among the cases. Oxygen was delivered at low-flow rates at the laryngeal inlet with LFO (n = 23) or high-flow rates at the nares with THRIVE (n = 12). Data regarding apnea time, the need for rescue ventilation, and relevant patient and disease factors were recorded for analysis. RESULTS Median apnea time for LFO and THRIVE were 34 and 25 minutes, respectively. Rescue with intermittent supraglottic jet ventilation was required more often with LFO than THRIVE (61% vs 33%) and was sufficient for the case to be completed in all but one instance. Elevated BMI was the sole significant predictor of early oxygen desaturation (24.8 vs 37.95 kg/m2 , P = .002) with LFO. Median stenosis diameter was 6 mm (range 2-14). CONCLUSION Apneic techniques are safe and feasible for the endoscopic management of subglottic stenosis of all severities. Elevated BMI is the only significant predictor for early oxygen desaturation. In the many healthcare settings where THRIVE is not available, LFO is a valid alterative in the nonobese patient. Laryngoscope, 2021.
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Affiliation(s)
- Daniel Luke Youssef
- Department of Otolaryngology, Head and Neck Surgery, Monash Health, Melbourne, Victoria, Australia
| | - Paul Paddle
- Department of Otolaryngology, Head and Neck Surgery, Monash Health, Melbourne, Victoria, Australia.,Department of Surgery, Monash University, Melbourne, Victoria, Australia
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Jung J, Chung YH, Chae WS. A novel application of Transnasal Humidified Rapid Insufflation Ventilatory Exchange via the oral route in morbidly obese patient during monitored anesthesia care - A case report. Anesth Pain Med (Seoul) 2020; 15:505-509. [PMID: 33329856 PMCID: PMC7724123 DOI: 10.17085/apm.20043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/04/2020] [Accepted: 07/23/2020] [Indexed: 11/17/2022] Open
Abstract
Background Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is used to improve oxygenation, with the added benefit of a smaller increase in CO2 if self-respiration is maintained with THRIVE. Despite these advantages, the use of THRIVE through a nasal cannula is limited in situations such as epistaxis or a basal skull fracture. Case We successful used THRIVE, through the oral route under general anesthesia with spontaneous breathing in a morbidly obese patient (weight, 148 kg; height, 183 cm; body mass index, 44.2 kg/m2) who received transnasal steroid injections due to subglottic stenosis. Conclusions THRIVE through the oral route may be an effective novel option, although further studies are needed.
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Affiliation(s)
- Jaewoong Jung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Yang-Hoon Chung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Won Seok Chae
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Benninger MS, Zhang ES, Chen B, Tierney WS, Abdelmalak B, Bryson PC. Utility of Transnasal Humidified Rapid Insufflation Ventilatory Exchange for Microlaryngeal Surgery. Laryngoscope 2020; 131:587-591. [PMID: 32542687 DOI: 10.1002/lary.28776] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/04/2020] [Accepted: 05/07/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Microlaryngeal surgery typically requires oxygenation and ventilation via either an endotracheal tube (ETT), jet ventilation (JV), or intermittent apnea with an ETT. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) delivered by high flow nasal cannula has been reported as an alternative technique. This method of apneic oxygenation and ventilation allows for stable, unobstructed visualization of immobile laryngeal structures. We aim to describe the technique and characterize intraoperative parameters related to its safety. STUDY DESIGN Case Series. METHODS The electronic medical record was reviewed for patients who underwent microlaryngoscopy using THRIVE technique. Patient demographics, procedural details, operative parameters, and anesthesia records were reviewed. Descriptive statistics were reported. RESULTS A total of 53 patients underwent microlaryngoscopy using THRIVE as the sole method of ventilation, with 62% female. Median age was 51 years, and median BMI was 25 kg/m2 . Most patients were ASA class 2, and most had a Mallampati score of 2. The most common surgical indications were subglottic stenosis, vocal fold lesions, and vocal fold paralysis. Median apnea time was 16 minutes. At the end of case, median end tidal CO2 was 50 mmHg, and median minimum SpO2 was 95. Six cases required supplementation of THRIVE with JV or tracheal intubation for sustained oxygen desaturation. There was an increase in end tidal CO2 of 0.844 mmHg/min of apneic time. CONCLUSIONS THRIVE is a safe and effective technique for oxygenation and ventilation in microlaryngeal, non-laser surgery in appropriately selected patients. To ensure safety, back-up plans such as jet ventilation and microlaryngeal ETT should be available. LEVEL OF EVIDENCE 4 Laryngoscope, 131:587-591, 2021.
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Affiliation(s)
| | - Emily S Zhang
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, U.S.A
| | - Bonnie Chen
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | | | - Basem Abdelmalak
- Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Paul C Bryson
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.,Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, U.S.A.,Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
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Waters E, Kellner M, Milligan P, Adamson RM, Nixon IJ, McNarry AF. The use of Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE) in one hundred and five upper airway endoscopies. A case series. Clin Otolaryngol 2019; 44:1115-1119. [DOI: 10.1111/coa.13408] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/04/2019] [Accepted: 06/27/2019] [Indexed: 11/30/2022]
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19
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A review of the use of transnasal humidified rapid insufflation ventilatory exchange for patients undergoing surgery in the shared airway setting. J Anesth 2019; 34:134-143. [DOI: 10.1007/s00540-019-02697-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/05/2019] [Indexed: 12/19/2022]
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20
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Stewart KE, McNarry AF, Nixon IJ. Transnasal humidified rapid insufflation ventilatory exchange in elective laryngopharyngoscopy. Clin Otolaryngol 2019; 44:1239-1241. [PMID: 31557395 DOI: 10.1111/coa.13447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Kirsten E Stewart
- Department of Head & Neck Surgery, St John's Hospital at Howden, Livingston, UK
| | | | - Iain J Nixon
- Department of Head & Neck Surgery, St John's Hospital at Howden, Livingston, UK
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