Biomarkers for oxidative stress and organ injury during Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange compared to mechanical ventilation in adults undergoing microlaryngoscopy: A randomised controlled study

Abstract

Background Apnoeic oxygenation using Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE) during general anaesthesia prolongs the safe apnoeic period. However, there is a gap of knowledge how THRIVE‐induced hyperoxia and hypercapnia impact vital organs. The primary aim of this randomised controlled trial was to characterise oxidative stress and, secondary, vital organ function biomarkers during THRIVE compared to mechanical ventilation (MV). Methods Thirty adult patients, American Society of Anesthesiologists (ASA) 1–2, undergoing short laryngeal surgery under general anaesthesia were randomised to THRIVE, FIO2 1.0, 70 L min−1 during apnoea or MV. Blood biomarkers for oxidative stress, malondialdehyde and TAC and vital organ function were collected (A) preoperatively, (B) at procedure completion and (C) at PACU discharge. Results Mean apnoea time was 17.9 (4.8) min and intubation to end‐of‐surgery time was 28.1 (12.8) min in the THRIVE and MV group, respectively. Malondialdehyde increased from 11.2 (3.1) to 12.7 (3.1) µM (P = .02) and from 9.5 (2.2) to 11.6 (2.6) µM (P = .003) (A to C) in the THRIVE and MV group, respectively. S100B increased from 0.05 (0.02) to 0.06 (0.02) µg L−1 (P = .005) (A to C) in the THRIVE group. No increase in TAC, CRP, leukocyte count, troponin‐T, NTproBNP, creatinine, eGFRcrea or NSE was demonstrated during THRIVE. Conclusion While THRIVE and MV was associated with increased oxidative stress, we found no change in cardiac, inflammation or kidney biomarkers during THRIVE. Further evaluation of stress and inflammatory response and cerebral and cardiac function during THRIVE is needed.

Tracheal Extubation Under Deep Anesthesia Using Transnasal Humidified Rapid Insufflation Ventilatory Exchange vs. Awake Extubation: An Open-Labeled Randomized Controlled Trial

“…A previous study demonstrated that THRIVE allows for a median apnoea time of 20-45 min (20,21). And as reported in several studies, THRIVE secured adequate oxygenation during induction and maintenance of anesthesia employing target-controlled propofol infusion and deep neuromuscular blockade in patients undergoing laryngo-microsurgery (22)(23)(24). We hypothesize, that tracheal extubation under deep anesthesia using THRIVE can effectively decrease the risk of hypoxaemia, agitation, hypertension and tachycardia, providing a more comfortable experience to patients following emergence from general anesthesia compared to awake extubation.…”

Apneic oxygenation in pediatric anesthesia

“…Regarding oxidative stress, again, no data exist from children. A study in adults undergoing laryngeal surgery with either apneic oxygenation using HFNO or mechanical ventilation found an increase in oxidative stress in both groups, with no difference between groups [23 ▪▪ ].…”