Laser Laryngeal Surgery Is Safe Under THRIVE

by Linda Kossoff •

Can transnasal humidified rapid insufflation ventilatory exchange (THRIVE) be used during laser laryngeal surgery (LLS) for apneic ventilation and oxygenation during laryngeal procedures? 

BOTTOM LINE

By eliminating the fuel component of the fire triangle, THRIVE can be used safely for continuous delivery of high functional inspired oxygen (FiO2) concentration during LLS, provided there is adherence to institutional THRIVE-LLS protocols.

COMMENT: THRIVE represents the most interesting and potentially useful addition to the airway management toolkit for otolaryngologists performing laryngotracheal surgery that has come along in the past few years. From experience, THRIVE occasionally works in patients who do not tolerate jet ventilation, and vice versa.—Al Merati, MD

BACKGROUND: THRIVE is a standard method used for oxygenation and ventilation during laryngeal surgery, but its use for LLS has been questioned due to a perceived risk of surgical airway fire.

STUDY DESIGN: Retrospective study.

SETTING: Stanford University Hospital, Stanford, Calif.

SYNOPSIS: Researchers retrospectively reviewed cases of 172 patients who underwent LLS involving the CO2 or KTP laser between Oct. 15, 2015, and June 1, 2021, with THRIVE as the primary mode of oxygenation. The surgeries took place at a single institution that had developed a protocol for the safe use of THRIVE during LLS using minimal laser power/exposure and no flammable material in the airway. The most common primary diagnoses for LLS were subglottic stenosis (26.7%), recurrent respiratory papillomatosis (22.7%), and leukoplakia (12.2%). The CO2 laser was used in 79.1% of cases. Median lowest intraoperative oxygen saturation (SpO2) was 96%. Of all cases, 16.3% required a single intubation and 19.2% required multiple intubations. Mean apnea time for THRIVE-only cases was 32.1 minutes. Mean apnea time was significantly lower for patients who were obese or had a diagnosis of hypertension. There were no instances of complications across all 172 cases.

CITATION: Khan NC, Vukkadala N, Saxena A, et al. Safety and utility of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) for laser laryngeal surgery [published online ahead of print April 6, 2023]. Otolaryngol Head Neck Surg.