Tubeless Anesthesia in Subglottic Stenosis: Comparative Review of Apneic Low-Flow Oxygenation With THRIVE.

Abstract

Managing the shared airway in subglottic stenosis presents a unique challenge. Tubeless anesthesia with apneic oxygenation is increasingly being adopted as it overcomes the limitations of access to and visualization of the narrowed subglottis. Low-flow oxygenation (LFO) and transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) are two delivery techniques. We sought to compare their utility in this patient cohort. Retrospective cohort study. Thirty-five cases of endoscopic debridement of subglottic stenosis were retrospectively studied. Operative technique was consistent among the cases. Oxygen was delivered at low-flow rates at the laryngeal inlet with LFO (n=23) or high-flow rates at the nares with THRIVE (n=12). Data regarding apnea time, the need for rescue ventilation, and relevant patient and disease factors were recorded for analysis. Median apnea time for LFO and THRIVE were 34 and 25 minutes, respectively. Rescue with intermittent supraglottic jet ventilation was required more often with LFO than THRIVE (61% vs 33%) and was sufficient for the case to be completed in all but one instance. Elevated BMI was the sole significant predictor of early oxygen desaturation (24.8 vs 37.95kg/m2 , P= .002) with LFO. Median stenosis diameter was 6 mm (range 2-14). Apneic techniques are safe and feasible for the endoscopic management of subglottic stenosis of all severities. Elevated BMI is the only significant predictor for early oxygen desaturation. In the many healthcare settings where THRIVE is not available, LFO is a valid alterative in the nonobese patient. Laryngoscope, 132:1231-1236, 2022.