Abstract：
OBJECTIVE: Trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) has demonstrated utility in extending the apneic window in the perioperative setting. Its benefits in facilitating tubeless anesthesia are recognized during elective laryngotracheal surgeries. The use of THRIVE and administering higher fractional inspired oxygen concentrations in laser laryngeal surgery (LLS) remains controversial due to the theoretical risk of airway fires. A scoping review of the literature describing institutional experiences with THRIVE during LLS was conducted.
METHODS: A systematic scoping review of the literature was performed including PubMed, Medline, Embase, Scopus, JBI EBP Database, and Cochrane Library from inception to April 2023.
RESULTS: From the 472 articles identified in our review, nine articles were included representing 271 cases. THRIVE was used for preoxygenation and to maintain apneic oxygenation during LLS. Different institutional practices related to THRIVE parameters and intraoperative modifications during lasing were described in the literature, including cessation of THRIVE, reduction of FiO2 to 30%, and continuous 100% FiO2 oxygenation. One study described a brief ignition of the coating of a KTP laser fiber without injury to the patient. No adverse patient outcomes have been documented in the literature with THRIVE during LLS.
CONCLUSIONS: THRIVE is a safe and effective form of tubeless anesthesia and apneic oxygenation during LLS, with no adverse patient safety events reported in the literature. Key determinants to maintain safety include optimal patient and team selection, effective surgeon-anesthetist cooperation, and institutional protocols that govern intraoperative practice. Laryngoscope, 2024.
METHODS: A systematic scoping review of the literature was performed including PubMed, Medline, Embase, Scopus, JBI EBP Database, and Cochrane Library from inception to April 2023.
RESULTS: From the 472 articles identified in our review, nine articles were included representing 271 cases. THRIVE was used for preoxygenation and to maintain apneic oxygenation during LLS. Different institutional practices related to THRIVE parameters and intraoperative modifications during lasing were described in the literature, including cessation of THRIVE, reduction of FiO2 to 30%, and continuous 100% FiO2 oxygenation. One study described a brief ignition of the coating of a KTP laser fiber without injury to the patient. No adverse patient outcomes have been documented in the literature with THRIVE during LLS.
CONCLUSIONS: THRIVE is a safe and effective form of tubeless anesthesia and apneic oxygenation during LLS, with no adverse patient safety events reported in the literature. Key determinants to maintain safety include optimal patient and team selection, effective surgeon-anesthetist cooperation, and institutional protocols that govern intraoperative practice. Laryngoscope, 2024.
摘要：
目的：经鼻加湿快速吹气换气（THRIVE）已证明可用于延长围手术期的呼吸暂停窗。在选择性喉气管手术中，人们认识到其促进无管麻醉的好处。由于理论上存在气道火灾的风险，在激光喉部手术（LLS）中使用THRIVE和给予较高的吸入氧气浓度仍然存在争议。对描述LLS期间THRIVE的机构经验的文献进行了范围审查。
方法：对文献进行了系统的范围审查，包括PubMed，Medline,Embase,Scopus,JBIEBP数据库，和Cochrane图书馆从成立到2023年4月。
结果：从我们的综述中确定的472篇文章中，包括9篇文章，代表271起案件。THRIVE用于预氧合并在LLS期间维持呼吸暂停氧合。文献中描述了与激光发射过程中THRIVE参数和术中修改相关的不同机构实践。包括停止劳动，FiO2减少到30%，和连续100%FiO2氧合。一项研究描述了KTP激光光纤涂层的短暂点燃，而不会对患者造成伤害。在LLS期间，文献中没有记录到不良患者结局。
结论：THRIVE是一种安全有效的无管麻醉和LLS期间呼吸暂停氧合的形式，文献中未报道不良患者安全事件。维持安全的关键决定因素包括最佳的患者和团队选择，有效的外科医生-麻醉师合作，和管理术中实践的机构协议。喉镜,2024.
方法：对文献进行了系统的范围审查，包括PubMed，Medline,Embase,Scopus,JBIEBP数据库，和Cochrane图书馆从成立到2023年4月。
结果：从我们的综述中确定的472篇文章中，包括9篇文章，代表271起案件。THRIVE用于预氧合并在LLS期间维持呼吸暂停氧合。文献中描述了与激光发射过程中THRIVE参数和术中修改相关的不同机构实践。包括停止劳动，FiO2减少到30%，和连续100%FiO2氧合。一项研究描述了KTP激光光纤涂层的短暂点燃，而不会对患者造成伤害。在LLS期间，文献中没有记录到不良患者结局。
结论：THRIVE是一种安全有效的无管麻醉和LLS期间呼吸暂停氧合的形式，文献中未报道不良患者安全事件。维持安全的关键决定因素包括最佳的患者和团队选择，有效的外科医生-麻醉师合作，和管理术中实践的机构协议。喉镜,2024.
