Transnasal humidified rapid-insufflation ventilatory exchange safe for oxygen delivery during laser laryngeal surgery

Medically Reviewed By : Dr. Kamal Kant Kohli

Published On 2022-10-27 03:30 GMT | Update On 2022-10-27 08:51 GMT

USA: Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is getting acceptance as an effective and safe method for oxygenation and apneic ventilation during laryngeal procedures. However, its utility for laser laryngeal surgery (LLS) is controversial owing to the theoretical risk of airway fire. In a recent study, the researchers described their experiences of the continuous use of THRIVE during LLS.

They found that during LLS, THRIVE can be used safely to continuously deliver a high fractional percentage of oxygen by omitting the fuel component of the fire triangle. This was observed provided adherence to institutionally developed safe THRIVE-LLS protocols and close association between the surgery and anesthesia teams.

The study's findings will be presented at the AAO-HNSF 2022 Annual Meeting & OTO Experience by the author Neelaysh Vukkadala.

The researchers conducted a retrospective chart review of patients >/= 18 years who had undergone LLS involving the CO2 or KTP laser under general anesthesia. THRIVE was the primary mode of oxygenation. THRIVE with FiO2 1.0 (no blending) was used throughout the surgical procedure, even during laser use. Placement of endotracheal tube (ETT) was reserved for ventilation for persistent desaturations or decreasing hypercarbia. A total of 68 cases were identified. The mean age was 56.5 years.

Other findings of the study were as follows:

· 36.8% were overweight and 23.8% obese (BMI > 30).

· The most common primary diagnosis was subglottic stenosis (39.7%).

· In 85.3% of cases, the CO2 laser was used.

· The median lowest intra-op O2 saturation nadir was 96% (range 74-100).

· 57.4% of cases were conducted solely under THRIVE, 19.1% required one-time ETT placement, and 23.5% required multiple placements.

· Mean procedure duration was 38 minutes. Mean apnea time in cases solely completed with THRIVE was 27 minutes, and for patients requiring at least one intubation was 19 minutes.

· No cases needed conversion to jet ventilation or tracheal intubation with a laser ETT. BMI > 30 was associated with a significantly higher likelihood of intubation (χ2 12.7).

· There were no intra-operative complications. One patient required an emergent cricothyroidotomy due to airway obstruction from bleeding after extubation. There were no fires.

"By omitting the fuel component of the fire triangle, THRIVE can be used safely for continuous delivery of a high fractional percentage of oxygen during LLS," the researchers wrote, "provided adherence to institutionally developed safe THRIVE-LLS protocols and close cooperation between the surgical and anesthesia teams," they added.

Reference:

Safety and utility of transnasal humidified rapid-insufflation ventilatory exchange for laser laryngeal surgery. Presenting Author: Neelaysh Vukkadala, MD, Co-Author: Nergis Khan, Co-Author: Amit Saxena, MD, Co-Author: Edward Damrose, MD, Co-Author: Vladimir Nekhendzy, MD, Co-Author: C. Kwang Sung, MD, MS 09:45AM - 09:50AM EDT

Article Source : AAO-HNSF 2022 Annual Meeting

Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.

NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.

Medha Baranwal

Comments Policy

Our comments section is governed by our Comments Policy . By posting comments at Medical Dialogues you automatically agree with our Comments Policy , Terms And Conditions and Privacy Policy .

Surgical ablation during CABG linked to improved survival in patients with preexisting atrial fibrillation, new study finds

2025-07-23 15:15 GMT

Transnasal humidified rapid-insufflation ventilatory exchange safe for oxygen delivery during laser laryngeal surgery

Similar News

Patients continue to lose weight in the years after 'tummy tuck': Study

Young Breast Cancer Patients Have Low Risk of Isolated Locoregional Recurrence After Surgery: JAMA

A Qualitative Study Exploring the Aftermath of Traumatic Amputation on the Social Life of Lower Limb Amputees

Surgical ablation during CABG linked to improved survival in patients with preexisting atrial fibrillation, new study finds

Surgery and Ablation Offer Comparable Outcomes for Small Liver Tumors: Study

Younger age, prolonged Healing Time, and Burn Location tied to Poorer Long-Term Scar Outcomes in Children: Study

Higher the body mass index, higher the risk for complications after bariatric surgery: Study

Robotic-Assisted Hysterectomy More Costly but More Effective Than Open Surgery: Study