Feasibility of THRIVE oxygenation and intra-operative lung-protective ventilation in morbidly obese patients undergoing neurosurgical procedures

Abstract

The conduct of anesthesia in morbidly obese patients undergoing neurosurgical procedures can be challenging considering the multi-system organ involvement. Implementation of conventional lung-protective ventilation in morbidly obese patients can have a negative impact on the intra-cranial dynamics. We report a series of three patients with morbid obesity and a difficult airway for the neurosurgical procedure. The patients were oxygenated with high-flow oxygen devices to ensure an adequate oxygen reserve in the peri-operative period. A modified intra-operative lung-protective ventilation with normocarbia was implemented with no impact on the intra-cranial pressure in the prone position in two of the patients. Oxygenation with high-flow devices should be considered during the peri-operative period in morbidly obese patients to avert an adverse respiratory event, and a modified lung-protective ventilation technique is feasible with normal intra-cranial dynamics intra-operatively.

Apneic anesthesia with THRIVE for pediatric bronchial foreign body removal

“…During apneic oxygenation, alveolar oxygen uptake occurs due to concentration gradient allowing maintenance of oxygenation and high flows and cardiogenic oscillations improve the clearance of CO 2. [ 2 3 6 ] THRIVE combines the advantage of standard apneic oxygenation with CPAP and gaseous exchange through flow-dependent dead space flushing. [ 3 ] Patel et al [ 3 ] showed safe apnea time of 5–65 mins without arterial desaturation and the rate of increase in ETCO 2 was 0.15 kPa.…”