Application and Efficiency of Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange in Laryngeal Microsurgery

Abstract

Objectives/Hypothesis This study aimed to analyze the feasibility of transnasal humidified rapid‐insufflation ventilatory exchange (THRIVE) during laryngeal microsurgery (LMS) and investigated its efficiency and application according to the location of the lesion. Study Design Retrospective chart review. Methods Patients over 20 years of age who underwent LMS without underlying cardiac, pulmonary, or cerebrovascular disease were retrospectively reviewed. Overall, 54 patients with endotracheal intubation (ETI) and 44 patients with THRIVE were included. The operation and anesthesia time, induction and emergence time, oxygen saturation (SpO2), and transcutaneous carbon dioxide (TcCO2) levels were analyzed and compared between the two ventilation methods according to disease subsite. Results Compared with ETI, patients with THRIVE presented reduced operation time (16.3 ± 9.69 min vs. 21.9 ± 12.0 min), anesthesia time (33.6 ± 11.4 min vs. 45.4 ± 13.9 min), emergence time (6.73 ± 2.49 min vs. 8.52 ± 3.17 min), without significant decreases in SpO2 but with increased TcCO2 (10.9 ± 6.12% vs. 7.33 ± 3.86%). Comparing THRIVE to ETI for lesions at the glottis yielded similar findings, which were particularly more significant. However, lesions above the glottis presented no significant difference for any parameters between THRIVE and ETI groups. Lesions involving multiple subsites and prolonged operation time were risk factors for the intraoperative conversion of ventilation method. Conclusion THRIVE is reliable for maintaining oxygenation during LMS and is efficient in reducing the operation and emergence times, leading to shorter anesthesia time, especially for lesions at the glottis. However, caution is required administering THRIVE, when lesion involves multiple subsites, and when operation time is prolonged. Level of Evidence 3 Laryngoscope, 132:1061–1068, 2022

High-flow Nasal Cannula versus Conventional Ventilation in Laryngeal Surgery: A Systematic Review and Meta-analysis

“…Three studies [ 33 - 35 ] including 236 patients reported the duration of surgery as an outcome. The duration of surgery was significantly decreased in the THRIVE group as show in Figure 2 (OR -4.92, 95%CI -7.73 to -2.11) (GRADE: Moderate).…”

“…Laser is occasionally used in laryngeal surgery and airway fire is a potentially fatal complication. Several of the studies in both the HFNC and jet ventilation groups included patients undergoing laser surgery [ 15 , 46 , 35 ], with no cases of airway fire reported. Some studies have reported the use of THRIVE during laser cases without adverse events or airway fire by turning off the oxygen flow for 40 seconds before the use of laser or by decreasing the fraction of inspired oxygen and suctioning airway gases [ 5 , 46 ].…”

“…For the retrospective comparative studies, there was a risk of patient selection bias in choosing conventional ventilation or HFNC. This impact was minimized as the meta-analysis consisted mostly of prospective RCTs and only one retrospective study, which had a low risk of selection bias [ 35 ]. Despite the differences, the impact on length of hospital stay, mortality, or complication rate compared to conventional ventilation is uncertain.…”

“…Since Huang’s review of the use of THRIVE in apneic patients undergoing shared airway surgery [ 5 ], there have been more recent studies comparing HFNC to conventional ventilation strategies such as tracheal intubation and SHFJV in the setting of laryngologic surgery [ 32 - 35 ], but there has not yet been a comprehensive comparative systematic review and meta-analysis of each method’s efficacy. This study aims to compare the safety and efficacy of HFNC to conventional ventilation using tracheal intubation or jet ventilation during laryngeal surgery.…”

The effect of intraoperative transnasal humidified rapid-insufflation ventilatory exchange on emergence from general anesthesia in patients undergoing microlaryngeal surgery: a randomized controlled trial

“…Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is a new technique of apneic oxygenation [ 2 , 3 ]. Several exploratory studies have suggested that THRIVE could be used for apneic oxygenation during anesthesia induction and difficult airway management [ 3 – 10 ]. However, due to the insufficient carbon dioxide exchange capacity, the safety of applying THRIVE to patients without spontaneous respiration needs further evaluation.…”