Effects of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange versus Facemask on Safe Apneic Time in Edentulous Elderly: A Randomized Controlled Trial

Abstract

Background Edentulous elderly patients often face challenges in airway management and are susceptible to hypoxemia. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) provides high-flow nasal oxygenation, potentially extending safe apneic time (SAT). This study compared the efficacy of THRIVE versus facemask ventilation in improving oxygenation and extending SAT in edentulous elderly patients. Material/Methods Patients with more than 10 missing teeth and who were over 65 years old were randomly assigned to the facemask group (Group M, n =25) or the THRIVE group (Group T, n =25). Patients in Group M were pre-oxygenated with a facemask (6 L/min, FiO 2 100%), while patients in Group T were pre-oxygenated with their mouths closed via THRIVE (30 L/min, FiO 2 100%). After anesthesia induction, patients in Group M were ventilated with pressure-controlled ventilation. In Group T, the patient’s mouth was kept closed, and the flow rate was adjusted to 70 L/min. Four min after cisatracurium administration, ventilation was stopped in Group M while Group T continued to receive oxygen (70 L/min, FiO 2 100%). The primary outcome was SAT, which was attained at 4 min after injection of cisatracurium and ended when SpO 2 decreased to 95% or when apneic time reached 480 s. A secondary outcome was the reoxygenation time, defined as the time from the beginning of mechanical ventilation to the time when SpO 2 98% was reached. Results An SAT of 480 s was reached by all patients in Group T, but by only 6 patients in Group M ( P <0.05). Compared with Group M, the reoxygenation time in Group T was significantly shorter ( P <0.05). Conclusions As compared to facemask, THRIVE can extend the SAT, improve oxygenation, and reduce reoxygenation time.