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Randomized Controlled Trial
. 2023 Jun 13;23(1):202.
doi: 10.1186/s12871-023-02169-y.

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

Wei Wei #  1 , Xiang Li #  1 , Lili Feng  1 , Jiali Jiao  2 , Wenxian Li  1 , Yirong Cai  1 , Rui Fang #  3 , Yuan Han #  4
Affiliations
Randomized Controlled Trial

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

Wei Wei et al. BMC Anesthesiol. .

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.

Keywords: Emergence from general anesthesia; Laryngeal mask; Microlaryngeal surgery; THRIVE; Tubeless anesthesia.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Consort Flow Diagram. ETT endotracheal tube, LM laryngeal mask, MV mechanical ventilation THRIVE transnasal humidified rapid insufflation ventilatory exchange
Fig. 2
Fig. 2
Scatter chart of A intraoperative PtcCO2 and B postoperative PETCO2. Each line represents a single patient. THRIVE + LM group use orange solid circles and solid lines, while MV + ETT group use blue hollow circles and dotted lines. Five-pointed star represents the last record of the patient. During the intraoperative period, the PtcCO2 values increase with time of apneic oxygenation in the THRIVE + LM group. The PtcCO2 values are significantly higher in the THRIVE + LM group at 2, 4, 6, 8,10 min after the start of surgery. During the postoperative period, the PETCO2 values are significantly higher in the THRIVE + LM group at the end of the surgery, 5 and 10 min after the arrival of PACU. ETT endotracheal tube, LM laryngeal mask, MV mechanical ventilation, PACU post-anesthesia care unit, PETCO2 end-tidal carbon dioxide pressure, PtcCO2 transcutaneous carbon dioxide pressure, THRIVE transnasal humidified rapid insufflation ventilatory exchange
Fig. 3
Fig. 3
A photo of THRIVE operated in the study
See this image and copyright information in PMC

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