High-flow nasal cannula in nonlaser microlaryngoscopic surgery: a prospective study of 19 cases in a chinese population

Abstract

Background High-flow nasal cannula (HFNC) is a new type of oxygen therapy, but its application in surgery remains unclear, we tried to describe the application of HFNC in microlaryngoscopic surgery for the Chinese population. Methods Nineteen adults, American society of anesthesiology class (ASA) 1–2 patients with body mass index < 30 kg.m−2 underwent microlaryngoscopic surgery using HFNC for airway management. Outcomes included apnoea time, intraoperative oxygenation, carbon dioxide value, lactate value, and the relationship between the duration of apnoea time and carbon dioxide levels. Results A total of 19 patients underwent vocal cord tumor resection under a microlaryngoscope with HFNC as the sole method of ventilation. The mean age was 39.7 years old, and the mean BMI was 23.9 kg.m−2. The mean apnea time was 21.5 min. The SpO2 of 18 patients remained above 90%, and only 1 patient dropped to 88%. The average basal lactate and highest lactate value was 0.58 mmol. L−1 and 0.68 mmol.L−1. The difference between basal and highest lactate values was statistically significant (P < 0.05). The average highest PaCO2 value was 79.4 mmHg. The PaCO2 increased by 1.68 ± 0.12 mmHg every minute linearly. Conclusions In the case series we have observed that HFNC would be safe and effective oxygenation and ventilation technique for selected Chinese patients undergoing non-laser microlaryngoscopic surgery within 30 min. The tubeless technology reduces the complications of tracheal intubation and jet ventilation and clears the surgical field of vision. Trial registration Chinese Clinical Trial Registry (ChiCTR100049144).

Successful Application of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange in a Case of Subglottic Stenosis

“…However, this technique is associated with a higher incidence of desaturation, hypercapnia, and the requirement for rescue intervention compared to intermittent tracheal intubation [3]. Its application is limited by the duration of apnea, as CO 2 accumulation and progressive respiratory acidosis may occur during apneic periods, with published data indicating safety up to approximately 30 minutes [3,5]. Anesthetized individuals typically experience a decrease in systemic vascular resistance as the primary cardiovascular effect of acidosis resulting from hypercapnia [8].…”

“…In our case, THRIVE was effective in providing prolonged apneic oxygenation and tubeless anesthesia during a 55-minute balloon dilation surgery under general anesthesia and neuromuscular blockade. Different from other cases reported to date [5,10], our patient was intentionally ventilated via face mask at three different moments: after induction of anesthesia to confirm ease of ventilation, when the surgeon needed to replace the laryngoscope with the C-MAC® video laryngoscope to optimize the surgical view, and after the conclusion of the surgery to facilitate ventilation and promote CO 2 elimination. This allowed for the extension of apneic oxygenation throughout the 55-minute procedure without significant CO 2 accumulation or hemodynamic instability.…”

“…In recent years, there has been growing interest in the use of transnasal humidified rapid insufflation ventilatory exchange (THRIVE) during apnea for short laryngeal procedures. This technique employs a device capable of delivering continuous, warmed, and humidified oxygen with varying FiO 2 levels (up to 100%) at a high flow rate (up to 70 L/min) through a high-flow nasal cannula, facilitating prolonged apneic oxygenation [5]. THRIVE presents the advantages of providing a tubeless field, improving visibility, reducing the procedure time, and mitigating endotracheal injury associated with tracheal intubation, as well as air pressure injury caused by jet ventilation [5].…”

“…This technique employs a device capable of delivering continuous, warmed, and humidified oxygen with varying FiO 2 levels (up to 100%) at a high flow rate (up to 70 L/min) through a high-flow nasal cannula, facilitating prolonged apneic oxygenation [5]. THRIVE presents the advantages of providing a tubeless field, improving visibility, reducing the procedure time, and mitigating endotracheal injury associated with tracheal intubation, as well as air pressure injury caused by jet ventilation [5]. Despite these advantages, its use is limited by the length of the apnea, as carbon dioxide (CO 2 ) accumulation and progressive respiratory acidosis may occur during apneic periods [3,6].…”

Intraoperative Use of High-Flow Nasal Cannula in Elderly Patients Undergoing Hip Fracture Repair Under Spinal Anesthesia: A Randomized Controlled Study

“…The HFNC group exhibited notable advantages in maintaining respiratory parameters throughout the surgical procedure, particularly achieving significantly higher oxygen saturation (SpO 2 ) levels at various points in time. HFNC has also been used as respiratory support in sedated patients undergoing short interventions such as diagnostic and therapeutic bronchoscopy, with encouraging results [21][22][23][24].…”