The effect of intraoperative transnasal humidified rapid-insufflation ventilatory exchange on emergence from general anesthesia in patients undergoing microlaryngeal surgery: a randomized controlled trial

Abstract

Background Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) has received extensive attention for its utility in tubeless anesthesia. Still, the effects of its carbon dioxide accumulation on emergence from anesthesia have not been reported. This randomized controlled trial aimed at exploring the impact of THRIVE combined with laryngeal mask (LM) on the quality of emergence in patients undergoing microlaryngeal surgery. Methods After research ethics board approval, 40 eligible patients receiving elective microlaryngeal vocal cord polypectomy were randomly allocated 1:1 to two groups, THRIVE + LM group: intraoperative apneic oxygenation using THRIVE followed by mechanical ventilation through a laryngeal mask in the post-anesthesia care unit (PACU), or MV + ETT group: mechanically ventilated through an endotracheal tube for both intraoperative and post-anesthesia periods. The primary outcome was duration of PACU stay. Other parameters reflecting quality of emergence and carbon dioxide accumulation were also recorded. Results Duration of PACU stay (22.4 ± 6.4 vs. 28.9 ± 8.8 min, p = 0.011) was shorter in the THRIVE + LM group. The incidence of cough (2/20, 10% vs. 19/20, 95%, P < 0.001) was significantly lower in the THRIVE + LM group. Peripheral arterial oxygen saturation and mean arterial pressure during intraoperative and PACU stay, Quality of Recovery Item 40 total score at one day after surgery and Voice Handicap Index-10 score at seven days after surgery were of no difference between two groups. Conclusions The THRIVE + LM strategy could accelerate emergence from anesthesia and reduce the incidence of cough without compromising oxygenation. However, these benefits did not convert to the QoR-40 and VHI-10 scores improvement. Trial registration ChiCTR2000038652.

Laryngeal microsurgery under Transnasal Humidified Rapid Insufflation Ventilatory Exchange

“…This must be taken into account in the duration of postoperative monitoring, although a recent study of 40 patients suggests that THRIVE can shorten the duration of postoperative monitoring. 22 …”

“…This must be taken into account in the duration of postoperative monitoring, although a recent study of 40 patients suggests that THRIVE can shorten the duration of postoperative monitoring. 22 In laryngeal cancers, data reported the use of THRIVE are scarce. Yet, freeing the surgical site from obstacle appears crucial for the gesture accuracy and therefore for the disease control in a minimal invasive approach.…”

“…On the one hand, during THRIVE, capnia is not systematically monitored, and, on the other hand, apneic ventilation techniques are more prone to hypercapnia. This must be taken into account in the duration of postoperative monitoring, although a recent study of 40 patients suggests that THRIVE can shorten the duration of postoperative monitoring 22 …”