New Visionary in Upper Airway Surgeries–THRIVE, a Tubeless Ventilation

Bharathi, M.; Kumar, Matthew; Prakash, B; Shetty, Sandeep; Sivapuram, Kavya; Madhan, Sriram

doi:10.1007/s12070-021-02491-2

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…HFNO can provide continuous supply for patients with apnoea through the effect of apneic oxygenation during intubation period, so as long to prolong safe apnoea time [ 6 , 9 ]. Taking advantage of the fact that HFNO can significantly prolong the safe apnoea time, many medical institutions have successfully carried out tubeless anesthesia, especially in short operations with shared airway such as subglottic stenosis and upper airway surgeries [ 33 , 34 ]. However, studies recently published indicates that although the apneic oxygenation of HFNO can ensure the oxygenation of patients and maintain long-term tubeless anesthesia, it is easy to result in CO 2 accumulation and respiratory acidosis when the apnoea time is greater than 30 min [ 35 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effectiveness of high-flow nasal oxygen vs. standard facemask oxygenation for pre- and apneic oxygenation during anesthesia induction: a systematic review and meta-analysis

et al. 2022

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Background In recent years, high flow nasal oxygen (HFNO) has been widely used in clinic, especially in perioperative period. Many studies have discussed the role of HFNO in pre- and apneic oxygenation, but their results are controversial. Our study aimed to examine the effectiveness of HFNO in pre- and apneic oxygenation by a meta-analysis of RCTs. Methods EMBASE, PUBMED, and COCHRANE LIBRARY databases were searched from inception to July 2021 for relevant randomized controlled trails (RCTs) on the effectiveness of HFNO versus standard facemask ventilation (FMV) in pre- and apenic oxygenation. Studies involving one of the following six indicators: (1) Arterial oxygen partial pressure (PaO2), (2) End expiratory oxygen concentration (EtO2), (3) Safe apnoea time, (4) Minimum pulse oxygen saturation (SpO2min), (5) Oxygenation (O2) desaturation, (6) End expiratory carbon dioxide (EtCO2) or Arterial carbon dioxide partial pressure(PaCO2) were included. Due to the source of clinical heterogeneity in the observed indicators in this study, we adopt random-effects model for analysis, and express it as the mean difference (MD) or risk ratio (RR) with a confidence interval of 95% (95%CI). We conducted a risk assessment of bias for eligible studies and assessed the overall quality of evidence for each outcome. Results Fourteen RCTs and 1012 participants were finally included. We found the PaO2 was higher in HFNO group than FMV group with a MD (95% CI) of 57.38 mmHg (25.65 to 89.10; p = 0.0004) after preoxygenation and the safe apnoea time was significantly longer with a MD (95% CI) of 86.93 s (44.35 to 129.51; p < 0.0001) during anesthesia induction. There were no significant statistical difference in the minimum SpO2, CO2 accumulation, EtO2 and O2 desaturation rate during anesthesia induction between the two groups. Conclusions This systematic review and meta-analysis suggests that HFNO should be considered as an oxygenation tool for patients during anesthesia induction. Compared with FMV, continuous use of HFNO during anesthesia induction can significantly improve oxygenation and prolong safe apnoea time in surgical patients.

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Section: Discussionmentioning

confidence: 99%

Comparison of the effectiveness of high-flow nasal oxygen vs. standard facemask oxygenation for pre- and apneic oxygenation during anesthesia induction: a systematic review and meta-analysis

et al. 2022

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“…[6,9] Taking advantage of the fact that HFNO can significantly prolong the safe apnoea time, many medical institutions have successfully carried out tubeless anesthesia, especially in short operations with shared airway such as subglottic stenosis and upper airway surgeries. [40][41] However, studies recently published by Piosik ZM et al and Booth AWG et al indicates that although the apneic oxygenation of HFNO can ensure the oxygenation of patients and maintain long-term tubeless anesthesia, it is easy to result in CO2 accumulation and respiratory acidosis when the apnoea time is greater than 30 minutes. [32,42] This extends previous knowledge and has implications for the safe application of HFNO during prolonged procedures.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Effectiveness of High-Flow Nasal Oxygen vs. Standard Facemask Oxygenation for pre- and apneic oxygenation during Anesthesia Induction: A Systematic Review and Meta-analysis

Song

Sun

Shi

et al. 2021

Preprint

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BackgroundIn recent years, high flow nasal oxygen(HFNO) has been widely used in clinic, especially in perioperative period.Many studies have discussed the role of HFNO in pre- and apneic oxygenation, but their results are controversial.Our study aimed to examine the effectiveness of HFNO in pre- and apneic oxygenation by a meta-analysis ofRCTs.MethodsEMBASE, PUBMED, and COCHRANE LIBRARY databases were searched from inception to July 2021 for relevantrandomized controlled trails(RCTs) on the effectiveness of HFNO versus standard facemask ventilation(FMV) inpre- and apenic oxygenation. Studies involving one of the following six indicators: (1)Arterial oxygen partialpressure(PaO2), (2)End expiratory oxygen concentration(EtO2), (3)Safe apnoea time, (4)Minimum pulse oxygensaturation(SpO2min), (5)Oxygenation(O2) desaturation, (6)End expiratory carbon dioxide(EtCO2) or Arterial carbondioxide partial pressure(PaCO2) were included. We select random effect model or fixed effect model for analysisaccording to the heterogeneity of the article, and express it as the mean difference(MD) or risk ratio(RR) with aconfidence interval of 95%(95%CI). We conducted a risk assessment of bias for eligible studies and assessed theoverall quality of evidence for each outcome.Results14 RCTs and 1012 participants were finally included. We found the PaO2 was higher in HFNO group than FMVgroup with a MD(95% CI) of 57.38 mmHg(25.65 to 89.10; p=0.0004) after preoxygenation and the safe apnoeatime was significantly longer with a MD(95% CI) of 86.93 seconds(44.35 to 129.51; p<0.0001) during anesthesiainduction. There were no significant statistical difference in the minimum O2 saturation, CO2 accumulation, endexpiratory oxygen concentration and O2 desaturation rate during anesthesia induction between the two groups.ConclusionsThis systematic review and meta-analysis suggests that HFNO should be considered as an airway managementtool for patients with high-risk hypoxemia or difficult airway during anesthesia induction. Compared with FMV,continuous use of HFNO during anesthesia induction can significantly improve oxygenation and prolong safeapnoea time in surgical patients.

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“…The most prominent benefits of tubeless anesthesia are improved operative outcomes and reduced time to laryngoscopic suspension and surgery by providing a better view of an uninterrupted surgical field ( Fig. 2 ) [ 6 , 7 , 14 , 32 ]. Furthermore, postoperative patient comfort, as assessed by nausea, vomiting, and agitation, was acceptable because tubeless anesthesia is maintained only by total intravenous anesthesia [ 7 , 30 , 32 ].…”

Section: Impact Of Tubeless Anesthesia On Patient Outcomementioning

confidence: 99%

“…2 ) [ 6 , 7 , 14 , 32 ]. Furthermore, postoperative patient comfort, as assessed by nausea, vomiting, and agitation, was acceptable because tubeless anesthesia is maintained only by total intravenous anesthesia [ 7 , 30 , 32 ]. These advantages allow tubeless anesthesia to be frequently used in the field of otorhinolaryngology for various upper airway surgeries ranging from microlaryngeal excision to surgery for subglottic stenosis.…”

Section: Impact Of Tubeless Anesthesia On Patient Outcomementioning

confidence: 99%

“…Tubeless anesthesia can be a good option for supraglottic and glottic tumors because endotracheal intubation is challenging. Despite providing tubeless anesthesia and partial obstruction from surgical instruments, especially when the lesion is located in the glottis, transcutaneous CO 2 levels are increasing more rapidly [ 7 ].…”

Section: Strategy Of Tubeless Anesthesia For Upper Airway Surgerymentioning

confidence: 99%

See 1 more Smart Citation

Tube or tubeless: an anesthetic strategy for upper airway surgery

Min¹,

Seo

2023

Anesth Pain Med

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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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New Visionary in Upper Airway Surgeries–THRIVE, a Tubeless Ventilation

Cited by 6 publications

References 9 publications

Comparison of the effectiveness of high-flow nasal oxygen vs. standard facemask oxygenation for pre- and apneic oxygenation during anesthesia induction: a systematic review and meta-analysis

Comparison of the effectiveness of high-flow nasal oxygen vs. standard facemask oxygenation for pre- and apneic oxygenation during anesthesia induction: a systematic review and meta-analysis

Comparison of the Effectiveness of High-Flow Nasal Oxygen vs. Standard Facemask Oxygenation for pre- and apneic oxygenation during Anesthesia Induction: A Systematic Review and Meta-analysis

Tube or tubeless: an anesthetic strategy for upper airway surgery

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