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Utility of Transnasal Humidified Rapid Insufflation Ventilatory Exchange for Microlaryngeal Surgery
Author(s) -
Benninger Michael S.,
Zhang Emily S.,
Chen Bonnie,
Tierney William S.,
Abdelmalak Basem,
Bryson Paul C.
Publication year - 2021
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.28776
Subject(s) - medicine , insufflation , nasal cannula , anesthesia , surgery , oxygenation , subglottic stenosis , apnea , intubation , ventilation (architecture) , rapid sequence induction , cannula , airway , mechanical engineering , engineering
Objective Microlaryngeal surgery typically requires oxygenation and ventilation via either an endotracheal tube (ETT), jet ventilation (JV), or intermittent apnea with an ETT. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) delivered by high flow nasal cannula has been reported as an alternative technique. This method of apneic oxygenation and ventilation allows for stable, unobstructed visualization of immobile laryngeal structures. We aim to describe the technique and characterize intraoperative parameters related to its safety. Study Design Case Series. Methods The electronic medical record was reviewed for patients who underwent microlaryngoscopy using THRIVE technique. Patient demographics, procedural details, operative parameters, and anesthesia records were reviewed. Descriptive statistics were reported. Results A total of 53 patients underwent microlaryngoscopy using THRIVE as the sole method of ventilation, with 62% female. Median age was 51 years, and median BMI was 25 kg/m 2 . Most patients were ASA class 2, and most had a Mallampati score of 2. The most common surgical indications were subglottic stenosis, vocal fold lesions, and vocal fold paralysis. Median apnea time was 16 minutes. At the end of case, median end tidal CO 2 was 50 mmHg, and median minimum SpO 2 was 95. Six cases required supplementation of THRIVE with JV or tracheal intubation for sustained oxygen desaturation. There was an increase in end tidal CO 2 of 0.844 mmHg/min of apneic time. Conclusions THRIVE is a safe and effective technique for oxygenation and ventilation in microlaryngeal, non‐laser surgery in appropriately selected patients. To ensure safety, back‐up plans such as jet ventilation and microlaryngeal ETT should be available. Level of Evidence 4 Laryngoscope , 131:587–591, 2021