Trans-nasal rapid insufflation humidified ventilatory exchange (THRIVE) in laryngeal microsurgery

Abstract

Microlaryngeal surgery is a delicate surgery that requires close collaboration between the ENT and anesthesia teams. THRIVE consists of the oxygenation technique by which the time of apneic oxygenation is prolonged, using conditioned high-flow oxygen to be delivered optimally, achieving adequate oxygenation but producing progressive hypercapnia. It ad­dresses the drawbacks of other methods used during microlaryngeal surgery, such as jet-ven­tilated vocal fold movement, vision obstructed by a tube, and trauma and disruptions from intermittent intubations. This can improve surgical precision, decrease operative time, and potentially improve patient outcomes. This article presents a narrative review of the use of THRIVE in laryngeal microsurgery. THRIVE is safe and effective for oxygenation in microlaryngeal surgery in appropriately selected patients. It allows for optimizing surgical exposure, potentially reducing surgical times. Additionally, it is a good alternative for cases where the endotracheal tube may hinder resection or traumatize the lesion.