Effect of trans-nasal humidified rapid insufflation ventilatory exchange on reflux and microaspiration in patients undergoing laparoscopic cholecystectomy during induction of general anesthesia: a randomized controlled trial
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PROVIDER: S-EPMC10512709 | biostudies-literature | 2023 Jan
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Project description:Background: Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) was used to extend the safe apnea time. However, THRIVE is only effective in patients with airway opening. Nasopharyngeal airway (NPA) is a simple device that can help to keep airway opening. This study aimed to investigate the noninferiority of NPA to jaw thrust for airway opening during anesthesia-induced apnea. Methods: This was a prospective randomized single-blinded noninferiority clinical trial on the use of THRIVE in patients with anesthesia-induced apnea. The participants were randomly allocated to receive NPA or jaw thrust. The primary outcomes were PaO2 and PaCO2 at 20 min after apnea, with noninferiority margin criteria of -6.67 and 0.67 kPa, respectively. Results: A total of 123 patients completed the trial: 61 in the NPA group and 62 in the jaw thrust group. PaO2 at 20 min after apnea was 42.9 ± 14.0 kPa in the NPA group and 42.7 ± 13.6 kPa in the jaw thrust group. The difference between these two means was 0.25 kPa (95% CI, -3.87 to 4.37 kPa). Since the lower boundary of the 95% CI was > -6.67 kPa, noninferiority was established because higher PO2 is better. PaCO2 at 20 min after apnea was 10.74 ± 1.09 kPa in the NPA group and 10.54 ± 1.18 kPa in the jaw thrust group. The difference between the two means was 0.19 kPa (95% CI, -0.14 to 0.53 kPa). Since the upper boundary of the 95% CI was <0.67 kPa, noninferiority was established because lower PCO2 is better. No patient had a SpO2 < 90% during apnea. Conclusion: When THRIVE was applied during anesthesia-induced apnea, NPA placement kept airway opening and was noninferior to jaw thrust in terms of its effects on PaO2 and PaCO2 at 20 min after apnea. Clinical Trial Registration: ClinicalTrials.gov (NCT03741998).
| S-EPMC7729126 | biostudies-literature
Project description:BackgroundTransnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) has received increasing attention and application as an effective noninvasive mode of ventilation in the treatment of clinical anesthesia and critically ill patients. The conclusions reached in clinical studies of THRIVE and facemask oxygenation are still controversial, and the main objective of this systematic review is to determine the advantages of THRIVE over facemask oxygenation in intensive care units, respiratory medicine, and perioperative preoxygenation.MethodsPubMed, Embase, Web of Science, and Cochrane Library have search restrictions. The search library was full of English language articles from the first publication to 15 July 2021. Eligible randomized controlled study designs were included. 245 records were screened, and 5 studies met the inclusion criteria, enrolling a total of 235 patients.ResultsStudying the THRIVE group compared to the facemask group, three studies analyzing intubation time showed that there is no difference in the effect of THRIVE and facemasks (MD -1.22, 95% CI -7.23 to 4.78, and P = 0.69 > 0.05). Three studies analyzing apnea showed that there was no difference between the two groups (SMD 1, 95% CI -0.76 to 2.76, and P = 0.27 > 0.05). Three studies analyzing PaO2 after preoxygenation showed that THRIVE is more effective than facemasks (MD 72.58, 95% CI 31.25 to 113.90, Z = 3.44, and P < 0.001). Two studies analyzing oxygen saturation SpO2 after successful intubation showed that there was no difference in the effectiveness (MD 0.09, 95% CI -1.03 to 1.22, and P = 0.87 > 0.05). Two studies analyzing PCO2 after complete paralysis or intubation preoxygenation showed that there was no difference between the two groups (MD 2.76, 95% CI -1.74 to 7.26, and P = 0.23 > 0.05).ConclusionsTHRIVE does not have a greater advantage over a facemask in improving apnea time, oxygenation time, PCO2, and SpO2, but it has an advantage in improving arterial partial pressure of oxygen (PaO2) after preoxygenation, which can improve PaO2 well. This trial is registered with the protocol registration number CRD42021268143.
| S-EPMC9300319 | biostudies-literature
Project description:Transnasal humidified rapid insufflation ventilator exchange (THRIVE) may be effective in delaying hypoxia, but the efficacy of THRIVE for oxygenation in elderly patients under general anaesthesia has not been assessed. This study assessed whether THRIVE prolonged the apnoea time in the elderly patients after induction. This was a single centre, two-group, randomized controlled trial. 60 patients (65 to 80 years of age) with American Society of Anesthesiologists (ASA) grades I ~ III who required tracheal intubation or the application of a laryngeal mask under general anaesthesia were randomly allocated to receive oxygenation using THRIVE (100% oxygen, 30~70 litres min-1) or a facemask (100% oxygen, 10 litres min-1) during the pre-oxygenation period and during apnoea. The apnoea time, which was defined as the time from the cessation of spontaneous breathing until the SpO2 decreased to 90% or the apnoea time reached 10 minutes was recorded as the primary outcome. No significant differences were found on the baseline characteristics between the groups. The apnoea time was significantly increased (P < 0.01) in the THRIVE group. The median (interquartile range) apnoea times were 600 (600-600) s in the THRIVE group and 600 (231.5-600) s in the facemask group. No significant differences were found in the PaO2, PaCO2 and vital parameters between the THRIVE and facemask groups. No increased occurrence of complications, including haemodynamic instability, resistant arrhythmia or nasal discomfort, were reported in both the THRIVE group and the facemask group. THRIVE prolongs the apnoea time in elderly patients. THRIVE may be a more effective method for pre-oxygenation than a facemask in the elderly without pulmonary dysfunction.
| S-EPMC7113239 | biostudies-literature
Project description:IntroductionEmergency intubation of children with abnormal respiratory or cardiac physiology is a high-risk procedure and associated with a high incidence of adverse events including hypoxemia. Successful emergency intubation is dependent on inter-related patient and operator factors. Preoxygenation has been used to maximise oxygen reserves in the patient and to prolong the safe apnoeic time during the intubation phase. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) prolongs the safe apnoeic window for a safe intubation during elective intubation. We designed a clinical trial to test the hypothesis that THRIVE reduces the frequency of adverse and hypoxemic events during emergency intubation in children and to test the hypothesis that this treatment is cost-effective compared with standard care.Methods and analysisThe Kids THRIVE trial is a multicentre randomised controlled trial performed in participating emergency departments and paediatric intensive care units. 960 infants and children aged 0-16 years requiring emergency intubation for all reasons will be enrolled and allocated to THRIVE or control in a 1:1 allocation with stratification by site, age (<1, 1-7 and >7 years) and operator (junior and senior). Children allocated to THRIVE will receive weight appropriate transnasal flow rates with 100% oxygen, whereas children in the control arm will not receive any transnasal oxygen insufflation. The primary outcomes are defined as follows: (1) hypoxemic event during the intubation phase defined as SpO2 <90% (patient-dependent variable) and (2) first intubation attempt success without hypoxemia (operator-dependent variable). Analyses will be conducted on an intention-to-treat basis.Ethics and disseminationEthics approval for the protocol and consent process has been obtained (HREC/16/QRCH/81). The trial has been actively recruiting since May 2017. The study findings will be submitted for publication in a peer-reviewed journal.Trial registration numberACTRN12617000147381.
| S-EPMC6398737 | biostudies-literature
Project description:The placement of an endotracheal tube for children with acute or critical illness is a low-frequency and high-risk procedure, associated with high rates of first-attempt failure and adverse events, including hypoxaemia. To reduce the frequency of these adverse events, the provision of oxygen to the patient during the apnoeic phase of intubation has been proposed as a method to prolong the time available for the operator to insert the endotracheal tube, prior to the onset of hypoxaemia. However, there are limited data from randomised controlled trials to validate the efficacy of this technique in children. The technique known as transnasal humidified rapid insufflation ventilatory exchange (THRIVE) uses high oxygen flow rates (approximately 2 L/kg/min) delivered through nasal cannulae during apnoea. It has been shown to at least double the amount of time available for safe intubation in healthy children undergoing elective surgery. The technique and its application in real time have not previously been studied in acutely ill or injured children presenting to the emergency department or admitted to an intensive care unit. The Kids THRIVE trial is a multicentre, international, randomised controlled trial (RCT) in children less than 16 years old undergoing emergent intubation in either the intensive care unit or emergency department of participating hospitals. Participants will be randomised to receive either the THRIVE intervention or standard care (no apnoeic oxygenation) during their intubation. The primary objective of the trial is to determine if the use of THRIVE reduces the frequency of oxygen desaturation and increases the frequency of first-attempt success without hypoxaemia in emergent intubation of children compared with standard practice. The secondary objectives of the study are to assess the impact of the use of THRIVE on the rate of adverse events, length of mechanical ventilation and length of stay in intensive care. In this paper, we describe the detailed statistical analysis plan as an update of the previously published protocol.
| S-EPMC10230452 | biostudies-literature
Project description:IntroductionMaintaining normothermia during anesthesia is imperative to provide quality patient care and to prevent adverse outcomes. Prolonged laparoscopic procedures have been identified as a potential risk factor for hypothermia, due to continuous insufflation of cold and dry carbon dioxide. Perioperative hypothermia is associated with increased hospital cost and many complications including; impaired drug metabolism, impaired immune function, cardiac morbidity, shivering, coagulopathy.MethodsIn this experimental study, four pigs underwent four interventions each, resulting in 16 total trials. Using standardized general anesthesia in a randomized Latin-square sequence the four interventions include: 1. Control group without an administered pneumoperitoneum, 2. Administered standard pneumoperitoneum using 21°C insufflated gas and under-body forced-air warming, 3. Administered pneumoperitoneum with insufflation of warmed/humidified carbon dioxide, 4. Administered pneumoperitoneum with insufflation of warmed/humidified carbon dioxide and under-body forced-air warming. The primary outcome was distal esophageal temperature change 4 hours after trocar insertion.ResultsFour hours after trocar insertion, pigs in the control group lost 2.1 ± 0.4°C; pigs with warmed and humidified insufflation lost 1.8 ± 0.4°C; pigs with forced-air warming group lost 1.3 ± 0.9°C; and pigs exposed to a combination of warmed and humidified insufflation with forced-air warming increased by 0.3 ± 0.2°C.ConclusionThis experimental animal study provides evidence that a combination of warmed and humidified insufflation of carbon dioxide (CO2) in conjunction with forced-air warming is an effective strategy in the prevention of perioperative hypothermia. Further clinical trials investigating humans are therefore indicated.
| S-EPMC6040690 | biostudies-literature
Project description:BackgroundTransnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) using high-flow 100% oxygen during apnoea has gained increased use during difficult airway management and laryngeal surgery due to a slower carbon dioxide rise compared to traditional apnoeic oxygenation. We have previously demonstrated high arterial oxygen partial pressures and an increasing arterial-alveolar carbon dioxide difference during THRIVE. Primary aim of this study was to characterise lung volume changes measured with electrical impedance tomography during THRIVE compared to mechanical ventilation.MethodsThirty adult patients undergoing laryngeal surgery under general anaesthesia were randomised to THRIVE or mechanical ventilation. Subjects were monitored with electrical impedance tomography and repeated blood gas measurement perioperatively. The THRIVE group received 100% oxygen at 70 l min-1 during apnoea. The mechanical ventilation group was intubated and normoventilated with an FiO2 of 0.4.ResultsMean age were 48.2 (19.9) and 51.3 (12.3) years, and BMI 26.0 (4.5) and 26.0 (3.9) in the THRIVE and mechanical ventilation group respectively. Mean apnoea time in the THRIVE group was 17.9 (4.8) min. Mean apnoea to end-of-surgery time was 28.1 (12.8) min in the mechanical ventilation group. No difference in delta End Expiratory Lung Impedance was seen between groups over time. In the THRIVE group all but three subjects were well oxygenated during apnoea. THRIVE was discontinued for the three patients who desaturated.ConclusionsNo difference in lung volume change over time, measured by electrical impedance tomography, was detected when using THRIVE compared to mechanical ventilation during laryngeal surgery.
| S-EPMC7589281 | biostudies-literature
Project description:BackgroundEpidemiological data demonstrate that the worldwide prevalence of chronic obstructive pulmonary disease is increasing. These patients have an increased risk of mortality and morbidity and have constant limitations in airflow. Comparing laparoscopic cholecystectomy (LC) in patients with chronic obstructive pulmonary disease (COPD) under spinal anesthesia (SA) and general anesthesia (GA).MethodsWe prospectively evaluated COPD patients who underwent laparoscopic cholecystectomy under general anesthesia (Group 1, n = 30) or spinal anesthesia (Group 2, n = 30) in our clinic between January 2016 and January 2018. Patients with COPD were further divided into groups according to their preoperative stages (Stage 1-4). Intraoperative vital findings, postoperative pain, complications, and length of hospitalization were compared between the general (GA) and spinal anesthesia (SA) groups.ResultsThe mean age of the patients in the GA group was 61.0 ± 6.7 years and was 61.0 ± 7.7 years in the SA group. In the GA and SA groups, the mean ASA score was 2.8 ± 0.6 and 2.9 ± 0.6, respectively, the mean operation duration was 31.7 ± 5.1 and 30.6 ± 5.1 min, respectively, and the length of hospitalization was 3.2 ± 1.7 and 1.5 ± 0.5 days, respectively. The partial carbon dioxide rates (PaCO2) at the postoperative 5th and 20th minutes were lower in the SA group than in the GA group. Further, the requirement for postoperative analgesia was lower in the SA group, and the length of hospitalization was significantly shorter in the SA group. There was no significant difference between the two groups in terms of operation duration.ConclusionLaparoscopic cholecystectomy is a rather safe procedure for COPD patients under general and spinal anesthesia. However, spinal anesthesia is preferred over general anesthesia as it has better postoperative analgesia and causes no impairment of pulmonary functions.
| S-EPMC6102808 | biostudies-literature
Project description:BackgroundPostoperative pain remains a common problem in gynecologic laparoscopy, especially in head zone-related regions, triggered by intra-abdominal pressure during capnoperitoneum. Humidified and prewarmed insufflation gas may ameliorate pain and be beneficial.MethodsThis prospective randomized controlled parallel group multi-arm single-center study investigated the effects of temperature and humidity of insufflation gas on postoperative pain during gynecologic laparoscopy with a duration ≥ 60 min. Female participants (18-70 years) were blinded and randomly assigned-computer generated-to either insufflation with dry cold CO2 with forced air warming blanket ("AIR"), humidified warm gas without forced air warming blanket ("HUMI"), or humidified warm gas with forced air warming blanket ("HUMI +"). We hypothesized that using humidified warm gas resulted in lower pain scores and less analgesic consumption. The primary endpoint postoperative pain was assessed for different pain localizations every 12 h during 7 days after surgery. Secondary endpoints were demand for painkillers and epidural anesthetics, length of stay in recovery room, and hospital stay. (Registration: ClinicalTrials.gov NCT02781194-completed).Results150 participants were randomized. Compared to group "AIR" (n = 48), there was significantly less pain in group "HUMI +" (n = 48) in the recovery room (- 1.068; 95% CI - 2.08 to - 0.061), as well as significantly less ibuprofen use at day two (- 0.5871 g ± 0.258; p-value = 0.0471). Other variables did not change significantly. Stratification for presence of endometriosis or non-previous abdominal surgery in patient history revealed significantly less pain in both groups "HUMI" (n = 50) and "HUMI +" versus group "AIR." Related side effects were not noted.ConclusionIn the overall population, the use of warm, humidified insufflation gas did not yield clinically relevant effects; however, in predisposed patients with endometriosis and who could otherwise expect high pain levels, warm and humidified gas may be beneficial.
| S-EPMC9085687 | biostudies-literature
Project description:Single-incision laparoscopic surgery also known as laparo-endoscopic single-site surgery for cholecystectomy is performed using a single umbilical skin incision through which a laparoscope and two instruments are introduced. It is virtually a "scarless" surgery. The present study was undertaken to evaluate the efficacy of single-incision laparoscopic cholecystectomy using conventional instruments and compare it with three-port laparoscopic cholecystectomy. Thirty patients who underwent single-incision cholecystectomy were compared to an equal number of patients who underwent three-port cholecystectomy. Both groups were assessed on the basis of operative time, intraoperative complications, postoperative pain, ambulation, hospital stay, and body image at first and third week. Single-incision cholecystectomy had the advantage of less postoperative pain, early ambulation, and better body image as compared to three-port cholecystectomy; the results being statistically significant. There was no statistically significant difference in operative time and hospital stay between the two groups. Single-incision laparoscopic cholecystectomy using conventional instruments is a safe and effective surgery. It gives better cosmetic results, almost scarless surgery, without increasing the cost of surgery.
| S-EPMC4692840 | biostudies-literature