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Randomized Controlled Trial
. 2025 Jan 2;25(1):1.
doi: 10.1186/s12871-024-02869-z.

Intravenous anesthesia with high-flow nasal cannula improves recovery in elderly undergoing ureteroscopic lithotripsy: a prospective controlled study

Lifei Tang #  1 , Ran Guo #  2 , Yaochen Quan #  1 , Haiwen Zhang  3 , Yingcong Qian  3 , Youjia Yu #  4 , Shaoyong Song #  5 , Jian Li #  6
Affiliations
Randomized Controlled Trial

Intravenous anesthesia with high-flow nasal cannula improves recovery in elderly undergoing ureteroscopic lithotripsy: a prospective controlled study

Lifei Tang et al. BMC Anesthesiol. .

Abstract

Background: Intravenous anesthesia with high-flow nasal cannula (HFNC) has been reported to benefit oxygen reserves and enhance postoperative recovery in surgeries requiring low neuromuscular blockade. This study investigated whether HFNC improves recovery quality in elderly undergoing ureteroscopic holmium laser lithotripsy (UHLL).

Methods: We enrolled 106 elderly patients undergoing UHLL, with 96 patients (48 per group) included in the final analysis. Patients were randomly assigned (1:1, stratified by sex) to receive either HFNC (HFNC group) or laryngeal mask airway (LMA) assisted general anesthesia (LMA group). The primary outcome was the Quality of Recovery 15-questionnaire (QoR-15) scores. Secondary outcomes included PACU stay duration, time to out-of-bed mobilization, length of hospital stay, airway dryness scores, surgeons' satisfaction, and postoperative complications.

Results: Compared to the LMA group, the HFNC group achieved significantly higher QoR-15 scores (125.5 [118.3-130.0] vs. 136.5 [126.3-139.0]; difference = -9, 95%CI, -11 to -5; P < 0.001) on the first postoperative day. For secondary outcomes, the HFNC group had a shorter PACU stay (difference = 11.6 min, 95% CI, 10.4-12.8 min), earlier out-of-bed mobilization (difference = 31.8 min, 95% CI, 30.6-33.1 min), lower mouth (difference = 2, 95% CI, 1-3) and throat dryness scores (difference = 2, 95% CI, 1-3) at 30 min post-operation, and lower rates of postoperative sore throat (14.6% vs. 0%; P = 0.019) and cough with sputum (odds ratio [OR] = 9.4, 95% CI, 1.1-78.4). No significant differences were observed between the groups for other measures.

Conclusions: HFNC can improve recovery quality in elderly patients after UHLL compared to LMA-assisted general anesthesia.

Trial registration: This trial was registered on July 20, 2023, in the Chinese Clinical Trial Registry (ChiCTR2300073757).

Keywords: Elderly; High flow nasal cannula; Intravenous anesthesia; Recovery quality; Ureteroscopic holmium laser lithotripsy.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was performed according to the Declaration of Helsinki, and all patients provided written informed consent for participation in the research study. Ethical approval for this study (Approval No: JMSF20230720) was provided by the Medical Service of the 904th Hospital on July 1, 2023. This study was registered in the Center of Chinese Clinical Trials Registry at http://www.chictr.org.cn (ChiCTR2300073757). Our manuscript reporting adheres to CONSORT guidelines for reporting clinical trials. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Trial flow diagram. LMA, laryngeal mask airway; HFNC, high flow nasal cannula
Fig. 2
Fig. 2
Comparision of the QOR-15 scores of LMA and HFNC group at PRE, POD1, POD2, POD3 and POD7. Data were expressed as median (horizontal bar), interquartile range (box) and the outliers (points). QOR-15, Quality of Recovery 15-questionnaire (QoR-15); LMA, laryngeal mask airway; HFNC, high flow nasal cannula; PRE, pre-operation; POD, post-operation day
Fig. 3
Fig. 3
Subgroup analysis of the QOR-15 scores at POD1. BMI: body mass index; CI, confidence interval
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