Tubeless anesthesia effective for Children undergoing surgery for recurrent respiratory papillomatosis

The effectiveness of tubeless anesthesia with transnasal humidified rapid insufflation ventilatory exchange (THRIVE) has not been well established, particularly in young patients. In a recently published research, the efficacy of Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) was analyzed in children having surgery for Juvenile Onset Recurrent Respiratory Papillomatosis (JORRP). The following are the important findings :

1. The research included a cohort of 28 children, ranging in age from 2 to 12 years, who were diagnosed with juvenile-onset recurrent respiratory papillomatosis (JORRP) and exhibited aberrant airway conditions. These participants were classified according to the ASA physical status II-III.

2. Interventions: Each participant was subjected to two interventions, which were administered in a random sequence with a 5-minute interval between them. The first intervention included the cessation of breathing without the administration of supplemental oxygen, while the subsequent intervention involved the cessation of breathing with the implementation of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE).

3. The major outcome assessed in this study was the length of apnea, which was defined as the time interval between extubation and the subsequent reintubation, together with the restart of regulated breathing.

4. Findings: The research revealed a statistically significant increase in the median duration of apnea throughout the THRIVE intervention as compared to the control period. The use of the THRIVE intervention yielded a significantly extended duration of apnea.

5. Secondary objectives included the assessment of the rate of transcutaneous carbon dioxide (Tcco2) elevation, the nadir of pulse oxygen saturation (Spo2) during apnea, and the incidence of unforeseen adverse events.

6. The research revealed that there was a larger rate of carbon dioxide (CO2) growth during the control period in comparison to the THRIVE period for both age cohorts, namely children aged 2 to 5 years and 6 to 12 years. This finding suggests that the use of the THRIVE technique contributed to the mitigation of elevated levels of carbon dioxide accumulation during episodes of apnea.

7. The study found that the lowest pulse oxygen saturation (Spo2) was considerably greater during the THRIVE period in comparison to the control period, suggesting improved oxygenation assistance during apnea.

8. In summary, the findings of this research indicate that the use of THRIVE may be considered a safe method to prolong apnea duration in pediatric patients with JORRP who are having surgery. Furthermore, it has been shown that THRIVE is beneficial in reducing the pace at which carbon dioxide levels rise during the procedure. Consequently, the research proposes THRIVE as a therapeutically feasible method for managing the airway during tubeless anesthesia in apneic pediatric patients.

The present study offers empirical support for the use of the THRIVE technique as an advantageous strategy in the management of airway conditions in pediatric patients diagnosed with juvenile-onset recurrent respiratory papillomatosis (JORRP) during surgical procedures. This method demonstrates enhanced safety measures and facilitates the prolongation of apnea intervals.

Reference-

Lei, Guiyu MD*; Wu, Lili MD*; Xi, Chunhua MD, PhD*; Xiao, Yang MD, PhD†; Wang, Guyan MD, PhD*. Transnasal Humidified Rapid Insufflation Ventilatory Exchange Augments Oxygenation in Children With Juvenile Onset Recurrent Respiratory Papillomatosis During Surgery: A Prospective Randomized Crossover Controlled Trial. Anesthesia & Analgesia 137(3):p 578-586, September 2023. | DOI: 10.1213/ANE.0000000000006521