Application and Efficiency of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange in Laryngeal Microsurgery

Gene Huh; Seihee Min; Sung-Dong Cho; Youn Joung Cho; Seong Keun Kwon

doi:10.1002/lary.29848

Application and Efficiency of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange in Laryngeal Microsurgery

Laryngoscope. 2022 May;132(5):1061-1068. doi: 10.1002/lary.29848. Epub 2021 Sep 8.

Authors

Gene Huh^{1

2}, Seihee Min³, Sung-Dong Cho^{1

2}, Youn Joung Cho⁴, Seong Keun Kwon^{1

2

5

6}

Affiliations

¹ Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
² Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
³ Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
⁴ Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
⁵ Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.
⁶ Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea.

PMID: 34495557
DOI: 10.1002/lary.29848

Abstract

Objectives/hypothesis: This study aimed to analyze the feasibility of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) during laryngeal microsurgery (LMS) and investigated its efficiency and application according to the location of the lesion.

Study design: Retrospective chart review.

Methods: Patients over 20 years of age who underwent LMS without underlying cardiac, pulmonary, or cerebrovascular disease were retrospectively reviewed. Overall, 54 patients with endotracheal intubation (ETI) and 44 patients with THRIVE were included. The operation and anesthesia time, induction and emergence time, oxygen saturation (SpO₂ ), and transcutaneous carbon dioxide (TcCO₂ ) levels were analyzed and compared between the two ventilation methods according to disease subsite.

Results: Compared with ETI, patients with THRIVE presented reduced operation time (16.3 ± 9.69 min vs. 21.9 ± 12.0 min), anesthesia time (33.6 ± 11.4 min vs. 45.4 ± 13.9 min), emergence time (6.73 ± 2.49 min vs. 8.52 ± 3.17 min), without significant decreases in SpO₂ but with increased TcCO₂ (10.9 ± 6.12% vs. 7.33 ± 3.86%). Comparing THRIVE to ETI for lesions at the glottis yielded similar findings, which were particularly more significant. However, lesions above the glottis presented no significant difference for any parameters between THRIVE and ETI groups. Lesions involving multiple subsites and prolonged operation time were risk factors for the intraoperative conversion of ventilation method.

Conclusion: THRIVE is reliable for maintaining oxygenation during LMS and is efficient in reducing the operation and emergence times, leading to shorter anesthesia time, especially for lesions at the glottis. However, caution is required administering THRIVE, when lesion involves multiple subsites, and when operation time is prolonged.

Level of evidence: 3 Laryngoscope, 132:1061-1068, 2022.

Keywords: Laryngology; airway stenosis; laryngeal surgery; microlaryngeal surgery; transnasal humidified rapid-insufflation ventilatory exchange.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Apnea / etiology
Humans
Insufflation* / methods
Intubation, Intratracheal / adverse effects
Microsurgery / adverse effects
Retrospective Studies