Laryngeal microsurgery under Transnasal Humidified Rapid Insufflation Ventilatory Exchange

Since 2015, Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) has been used in general anesthesia for preoxygenation or difficult exposure airway management. Its use offers new opportunities in laryngology. THRIVE increases apnea time and frees the access to the upper airway. However, its use may be less stable than orotracheal intubation. The main objective of this work was to evaluate the feasibility of laryngeal microsurgery under THRIVE including using Laser.

Retrospective.

A total of N = 99 patients with laryngeal microsurgery (with or without CO₂ laser) under THRIVE were included successively from January 1, 2020 to January 30, 2022.

Medical history, comorbidities, clinical and surgical data were extracted and analyzed. Two groups were constituted regarding the "success" (use of THRIVE along all the procedure) or the "failure" (need for an endotracheal tube) of the use of THRIVE during the procedure.

A failure occurred in N = 15/99 patients (15.2%) mainly due to refractory hypoxia. The odd ratios (OR) for THRIVE failure were: OR = 6.6 [2.9-35] for overweight (BMI >25 kg/m²); OR = 3.8 [1.7-18.7] for ASA score >2; OR = 4.7 [2.3-24.7] for the use of CO₂ laser. Elderly patients and patients with pulmonary pathology were not statistically at greater risk of THRIVE failure. No adverse event was described.

This work confirms the feasibility of laryngeal microsurgery under THRIVE, including with CO₂ laser. Overweight, ASA >2 and lower fraction of inspired oxygen during CO₂ laser use increased the risk for orotracheal intubation.