Transnasal Humidified Rapid-Insufflation Ventilatory Exchange During Electroconvulsive Therapy

Abstract

Background In electroconvulsive therapy (ECT), a generalized seizure is provoked under general anesthesia. Standard airway management is done by face mask ventilation, but this is difficult during generalized seizure. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is a method to increase apnea tolerance and permit apnea oxygenation. We hypothesize that THRIVE can oxygenate the patient during ECT and that it is comfortable for patients. Methods In this single-center feasibility study, 13 patients with a pharmacotherapy-resistant depressive disorder underwent 20 ECT sessions with the use of THRIVE. They received general anesthesia under standard monitoring and transcutaneous carbon dioxide monitoring. Afterward, they completed a survey comparing their prior experience with face mask oxygenation. Results There were no desaturations during the procedure, and patient comfort showed no difference in comparison to face mask. Compared with data from earlier ECT with face mask ventilation in the same patient, THRIVE did not seem to shorten seizure duration. Conclusions THRIVE is a novel, safe oxygenation method during ECT.

Prevention of Oxygen Desaturation in a Patient With Previous Experience of Severe Hypoxia in Modified Electroconvulsive Therapy by Transnasal Humidified Rapid-Insufflation Ventilator Exchange: A Case Report

“…Several reports have described the usefulness of THRIVE in ECT [ 5 , 17 , 18 ]. Jonker et al performed 20 sessions of ECT with THRIVE on 13 patients and observed no desaturation or patient discomfort during the procedure [ 17 ].…”

“…Several reports have described the usefulness of THRIVE in ECT [ 5 , 17 , 18 ]. Jonker et al performed 20 sessions of ECT with THRIVE on 13 patients and observed no desaturation or patient discomfort during the procedure [ 17 ]. Vaithialingam et al performed a crossover study in which each patient underwent the conventional face mask ventilation and the THRIVE methods in separate ECT sessions [ 5 ].…”

Anesthetic Influence on Electroconvulsive Therapy: A Comprehensive Review

“…Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is a method that enhances apnea tolerance and permits apnea oxygenation. 85 , 86 Some studies have revealed no significant difference in seizure duration between THRIVE and mask ventilation, indicating that THRIVE may not affect the efficacy of ECT. 85 Additionally, THRIVE usage has shown no airway complications such as nasal injury, hoarseness or pneumothorax in patients, indicating it can be an effective alternative for difficult airway or patients with mask phobia.…”

“… 85 , 86 Some studies have revealed no significant difference in seizure duration between THRIVE and mask ventilation, indicating that THRIVE may not affect the efficacy of ECT. 85 Additionally, THRIVE usage has shown no airway complications such as nasal injury, hoarseness or pneumothorax in patients, indicating it can be an effective alternative for difficult airway or patients with mask phobia. 85 , 86 Simultaneously, it has been observed that THRIVE leads to a sustained rise in carbon dioxide levels after seizure termination.…”

Trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) in neuroanesthesia practice: A review

“…have demonstrated the feasibility of using THRIVE in a small set of populations undergoing ECT. [ 6 8 ] A recent trial demonstrated that HFNO (Optiflow) is non-inferior to conventional facemask ventilation with regard to desaturation, gastric insufflation, seizure quality, and recovery in patients undergoing modified ECT. [ 15 ]…”