Abstract
Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is a novel method of apnoeic oxygenation and continuous delivery of warmed humidified oxygen at high flow rates of up to 70 L/min. We present a successfully managed case of a 50-year-old male, an operated case of medullary carcinoma thyroid with tracheomalacia, posttracheal stenting who presented in stridor due to a glottic chink. He was posted for elective coblation cordotomy and desloughing of tracheal stent. After a multidisciplinary evaluation and cross-consultation between the surgeons and anaesthesiologists, we decided to administer total intravenous anaesthesia and THRIVE to enhance the apnoeic period when sharing the airway and improving surgical access to the lesion. Effective anaesthetic management in such shared airway procedures is challenging. Using a small-sized endotracheal tube which hampers surgical vision, infraglottic jet ventilation which might cause barotrauma, maintaining spontaneous ventilation that can lead to movement in the surgical field or apnoeic ventilation using THRIVE are the various available techniques in such cases. THRIVE extends the safe apnoea period before desaturation occurs, thus facilitating tubeless general anaesthesia in laryngotracheal surgeries.
Published Version
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