Spontaneous Respiration Using Intravenous Anesthesia and High-Flow Nasal Oxygen (STRIVE-Hi) for Prolonged Rigid...

Rigid bronchoscopy in patients with functional single-lung physiology presents a considerable anesthetic challenge because interruption of spontaneous ventilation may rapidly result in severe hypoxemia. Although spontaneous respiration using intravenous anesthesia and high-flow nasal oxygen (STRIVE-Hi) has been described as a technique that facilitates prolonged apneic oxygenation, evidence regarding its application to preserve spontaneous ventilation during prolonged rigid bronchoscopy remains limited. A 55-year-old man with complete obstruction of the left main bronchus secondary to post-intubation tracheobronchial stenosis underwent prolonged rigid bronchoscopy using a modified STRIVE-Hi technique. High-flow nasal oxygen (70 L/min, fraction of inspired oxygen (FiO₂) 1.0) was combined with target-controlled total intravenous anesthesia using propofol (Eleveld model) and remifentanil (Minto model) to maintain spontaneous ventilation throughout the procedure. Bronchoscopy lasted approximately two hours. Four transient desaturation episodes (lowest peripheral oxygen saturation (SpO₂) 83%) occurred exclusively during balloon dilation and resolved after brief procedural pauses without conversion to positive-pressure ventilation or interruption of the intervention. Spontaneous ventilation was preserved from induction to emergence. This case demonstrates the feasibility of a modified STRIVE-Hi approach to facilitate prolonged rigid bronchoscopy while maintaining spontaneous ventilation in a patient with severely limited pulmonary reserve. Individualizing the anesthetic strategy according to respiratory physiology may represent a useful alternative in selected patients undergoing complex airway procedures.