Intra‐oral ignition of monopolar diathermy during transnasal humidified rapid‐insufflation ventilatory exchange (<scp>THRIVE</scp>)

Onwochei, Desire N.; El‐Boghdadly, Kariem; Oakley, Richard; Ahmad, Imtiaz

doi:10.1111/anae.13873

Cited by 46 publications

(31 citation statements)

References 9 publications

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“…The use of HFNO at an F i O 2 of 0.3 and with ‘controlled oxygen desaturation’ has been reported in 12 spontaneously breathing patients undergoing laser airway surgery . A case of airway ignition has arisen with the use of monopolar diathermy for hard palate biopsy under sedation with HFNO .…”

Section: Discussionmentioning

confidence: 99%

Apnoeic oxygenation with high‐flow nasal oxygen for laryngeal surgery: a case series

2017

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Surgery under apnoeic conditions with the use of high-flow nasal oxygen is novel. Between November 2016 and May 2017, 28 patients underwent tubeless laryngeal or tracheal surgery under apnoeic conditions with high-flow nasal oxygen as the sole method of gas exchange. Patients received total intravenous anaesthesia and neuromuscular blocking agents for the duration of their surgery. The median (IQR [range]) apnoea time was 19 (15-24 [9-37]) min. Four patients experienced an episode of oxygen desaturation to a value between 85% and 90%, lasting less than 2 min in each case. Median (IQR [range]) end-tidal carbon dioxide (ETCO ) level following apnoea was 8.2 (7.2-9.4 [5.8-11.8]) kPa. The mean (SD) rate of ETCO increase was 0.17 (0.07) kPa.min from an approximated baseline value of 5.00 kPa. Venous blood sampling from 19 patients demonstrated a mean (SD) partial pressure of carbon dioxide (P CO ) of 6.29 (0.71) kPa at baseline and 9.44 (1.12) kPa after 15 min of apnoea. This equates to a mean (SD) P CO rise of 0.21 (0.08) kPa.min during this period. Mean (SD) pH was 7.40 (0.03) at baseline and 7.23 (0.04) after 15 min of apnoea. Mean (SD) standard bicarbonate was 26.7 (1.8) mmol.l at baseline and 25.4 (1.8) mmol.l at 15 min. We conclude that high-flow nasal oxygen under apnoeic conditions can provide satisfactory gas exchange in order to allow tubeless anaesthesia for laryngeal surgery.

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Section: Discussionmentioning

confidence: 99%

Apnoeic oxygenation with high‐flow nasal oxygen for laryngeal surgery: a case series

2017

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“…However, the likelihood of native tissues rather than a tracheal tube acting as a fuel source is contested . A case of airway fire has occurred with the use of diathermy for hard palate biopsy in a patient receiving high‐flow nasal oxygen .…”

Section: Complications Of Apnoeic Oxygenationmentioning

confidence: 99%

Uses and mechanisms of apnoeic oxygenation: a narrative review

Lyons

Callaghan

2019

Anaesthesia

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Apnoeic oxygenation refers to oxygenation in the absence of spontaneous respiration or mechanical ventilation. It has been described in humans for over half a century and has seen a resurgence in interest given its potential to delay oxygen desaturation during airway management, especially with the advent of high-flow nasal cannulae. This narrative review summarises our current understanding of the mechanisms of gas exchange during apnoeic oxygenation and its diverse range of clinical applications, including its use at induction of anaesthesia and for the facilitation of 'tubeless anaesthesia'. Additional discussion covers use in critical care, obese, obstetric and paediatric sub-populations. The article also highlights current research efforts aiming to enhance the evidence base for the use of this technique.

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“…Intraoperative use of HFNO has been described during endoscopic procedures; dentistry; caesarean sections with spinal anaesthesia; and thoracic, otolaryngeal and neurosurgeries …”

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confidence: 99%