Apneic Oxygenation
Conditions
Keywords
airway management, high flow nasal cannula, laryngeal microsurgery
Brief summary
Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) was revealed to prolong apneic time with a slow increase in carbon dioxide; thus, has been used for preoxygenation in patients with difficult airways or requiring rapid sequence induction in general anesthesia. However, in patients undergoing hypopharyngeal and laryngo-tracheal surgery, THRIVE during operation can be advantageous by allowing tubeless surgical field with sufficient oxygenation. Therefore, the investigators conducted this study to evaluate the efficacy of THRIVE on prolonged apneic time with enhanced surgical conditions in patients with laryngeal microsurgery.
Detailed description
Patients undergoing laryngeal microsurgery will be randomized into either intubation group or THRIVE group. On arriving operating room, the patients will be preoxygenated by facemask or high flow nasal cannula with 100% oxygen for 3 minutes according to the allocated group. After inducing general anesthesia, patients in intubation group will be oxygenated by endotracheal tube, while patients in THRIVE group will be oxygenated by high flow nasal cannula with flow rate of 70L/min. During the surgery, the endotracheal tube can be removed and reintubated in intubation group patients to provide surgical field by a surgeon, respectively. The monitored pulse oximetry, oxygen reserve index, and transcutaneous partial pressure of carbon dioxide will be recorded during surgery.
Interventions
PROCEDUREendotracheal intubation
After preoxygenation with FiO2 1.0 and flow rate of 8 L/min for 3 minutes, the enrolled patients will be intubated with endotracheal tube and maintained oxygenation during surgery.
PROCEDUREhigh flow nasal cannula
After preoxygenation with 100% oxygen through high flow nasal cannula for 3 minutes, the enrolled patients will be maintained intubationless oxygenation with flow rate of 70 L/min during surgery.
Sponsors
Seoul National University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* patients undergoing laryngeal microsurgery * ASA class I-III
Exclusion criteria
* patients scheduled for laryngeal microsurgery using CO2 laser * patients with increased intracranial pressure * patients with skull base defect * patients with chronic obstructive pulmonary disease * patients with pulmonary hypertension * patients requiring rapid sequence induction
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| lowest oxygen saturation | from the time of starting laryngeal microsurgery till the end of the surgery | lowest oxygen saturation monitored by pulse oximetry during laryngeal microsurgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| lowest oxygen reserve index | from the time of starting laryngeal microsurgery till the end of the surgery | lowest oxygen reserve index monitored during laryngeal microsurgery |
| highest transcutaneous partial pressure of carbon dioxide | from the time of starting laryngeal microsurgery till the end of the surgery | highest transcutaneous partial pressure of carbon dioxide monitored during laryngeal microsurgery |
Countries
South Korea
Outcome results
None listed