Publication:

THRIVE: a different approach in microlaryngeal surgeries

Microlaryngeal surgeries (MLS) are typically performed under general anaesthesia either by employing a microlaryngeal tube or without endotracheal intubation using high frequency jet ventilation. Recently, trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) without ET tube can be used. It has no compromised view/ access as in MLS tube and no barotrauma/movement of vocal cords/ tumour implantation as in jet ventilation. We aimed to assess the feasibility and safety of tubeless MLS using THRIVE. From December 2019 to December 2020, all the patients undergoing tubeless MLS were included.  Anaesthesia was conducted with target controlled propofol infusion and muscle relaxation with THRIVE oxygen support. Perioperative data was collected and analysed. A total of 21 patients underwent MLS using THRIVE as the sole method of ventilation. Mean age was 52.6 (±13.77) years, and mean body mass index (BMI) was 25.63 (±4.91) kg/m2. The surgical indications were vocal cord tumor/ biopsy and vocal polyp/cyst excision. Mean apnoea time was 27 min. At the end of surgery, mean end tidal CO2 was 66 mmHg. Surgeon’s satisfaction about the operating field was recorded and he rated it as either excellent (70%) or good (30%). In carefully selected patients, a combination of THRIVE and TIVA offers a good alternative to conventional anaesthesia with tubes. Our study demonstrated a considerable safe apnoea time with an acceptable CO2 build up. Surgeon acceptance of the technique was extremely promising and the operating conditions were highly rated by them.