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