THIRVE in Foreign Body Bronchus Removal-A Novel Approach

We prospectively studied novel anesthetic and surgical approach to foreign body bronchus removal using HHFNC (heated humidified high flow nasal cannula)/THRIVE technique(Transnasal Humidified Rapid-Insufflation ventilatory Exchange) in eleven cases. MacIntosh Laryngoscope was used to expose laryngeal inlet and FB was removed with an optical forcep (mounted over 2.7 mm rigid bronchoscope) without using ventilating bronchosocope. Total intravenous anaesthesia (TIVA) was given in all cases. FB was removed completely in all eleven cases. The average duration of procedure was 4.5 min. HHFNC improved the apnoea time with 6 min as maximum procedure time. Induction with Fentanyl, Intermittent Propofol injection and succinylcholine prevented excessive coughing, irritation, movement of the patient, vocal cords and posterior tracheal wall. Time management during this novel approach is crucial starting from removal of FB and check bronchoscopy.