Scientific Session III - Dysphagia and Airway Management
ALA026 - Laryngeal Oxygen Concentration and Desaturation Rate During Microlaryngeal Laser Surgeries Using Transnasal Humidified Rapid Insufflation Ventilatory Exchange (Thrive) at Two Oxygen Concentration Deliveries
Friday, April 29, 2022
8:18 AM – 8:24 AM CT
Location: Landmark D
Daniel Novakovic, MD; Meet Sheth, MD; Duy-Duog Nguyen, MD
Director Dr Liang Voice Program - University of Sydney University of Sydney, New South Wales, Australia
Objectives: THRIVE using 100% oxygenation creates a risk of fire during laser microlaryngeal surgery. The purpose of this study is to describe the technique of THRIVE using laser safe (30%) oxygen conditions, measure the intraoperative real-time laryngeal oxygen concentration, and examine patient saturation status using this technique.
Methods: Prospective IRB approved study of patients undergoing tubeless laser microlaryngeal surgery using THRIVE. Delivered oxygen concentration was reduced from 100 to 30% before lasering using oxygen-air blender then increased to 100% post laser procedure. Outcome measures included time for laryngeal oxygen concentration to equalize to laser safe levels; Time to, methods of and duration of rescue ventilation; Desaturation rates and apneic times at both 100% and 30% oxygen deliveries.
Results: Forty-five patients were recruited (mean age = 47.5 years). Mean laryngeal oxygen concentration (%) at 100% and 30% deliveries was 98.46 and 31.45, respectively. Mean (SD) of laryngeal oxygen concentration equalization time to 30% (seconds) was 9.54 (3.78). At 30% oxygen delivery desaturation rate was faster and apneic time shorter compared with 100%. Fifteen patients required rescue (jet) ventilation and they had a faster apneic desaturation rate (%/minute) than patients not requiring rescue. Mean (SD) apneic time (minutes) was 4.53 (2.24) and 4.33 (1.29) in rescue vs non rescue groups respectively. BMI was the only significant predictor of desaturation rate at 30% oxygen delivery.
Conclusion: It is possible to achieve a safe time window for use of laser during microlaryngeal surgery using THRIVE by decreasing delivered oxygen concentration to 30%.