Comparison of the efficacy of high-flow nasal oxygenation and spontaneous breathing with face mask ventilation during panendoscopy.

Editor—Panendoscopy is a high-risk procedure where oxygenation and patient safety in the absence of tracheal intubation is compromised by the depth of anaesthesia required for the procedure. Currently, there are several methods to ensure oxygenation during this procedure but none is universally accepted. Whatever the method chosen, the risks to the patient remain significant, particularly during hypoxaemia during episodes of haemoglobin desaturation. Several studies have shown an increase in safe apnoea time with high-flow nasal oxygenation (HFNO) in patients at risk of difficult tracheal intubation. 1 Patel A. Nouraei S.A.R. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways. Anaesthesia. 2015; 70: 323-329 Crossref PubMed Scopus (449) Google Scholar , 2 Booth A.W.G. Vidhani K. Spontaneous ventilation using target-controlled propofol infusion for microlaryngoscopy in adults: a retrospective audit. Anaesth Intensive Care. 2016; 44: 285-293 Crossref PubMed Google Scholar , 3 Booth A.W.G. Vidhani K. Lee P.K. Thomsett C.-M. SponTaneous Respiration using IntraVEnous anaesthesia and Hi-flow nasal oxygen (STRIVE Hi) maintains oxygenation and airway patency during management of the obstructed airway: an observational study. Br J Anaesth. 2017; 118: 444-451 Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar , 4 Guy L. Christensen R. Dodd B. et al. The effect of transnasal humidified rapid-insufflation ventilator exchange (THRIVE) versus nasal prongs on safe apnoea time in paralysed obese patients: a randomised controlled trial. Br J Anaesth. 2022; 128: 375-381 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar The feasibility of this oxygenation method has been described in ear, nose, and throat surgery but in small samples. There was significantly increased apnoea time without desaturation, enabling surgery to be carried out in good conditions and without interference by a tracheal tube. 5 Lyons C. Callaghan M. Apnoeic oxygenation with high-flow nasal oxygen for laryngeal surgery: a case series. Anaesthesia. 2017; 72: 1379-1387 Crossref PubMed Scopus (51) Google Scholar , 6 Nekhendzy V. Saxena A. Mittal B. et al. The safety and efficacy of transnasal humidified rapid-insufflation ventilatory exchange for laryngologic Surgery. Laryngoscope. 2020; 130: E874-E881 Crossref PubMed Scopus (12) Google Scholar , 7 Waters E. Kellner M. Milligan P. Adamson R.M. Nixon I.J. McNarry A.F. The use of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) in one hundred and five upper airway endoscopies. A case series. Clin Otolaryngol. 2019; 44: 1115-1119 Crossref PubMed Scopus (18) Google Scholar , 8 Maupeu L. Raguin T. Hengen M. Diemunsch P. Schultz P. Indications of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) in laryngoscopy, a prospective study of 19 cases. Clin Otolaryngol. 2019; 44: 182-186 Crossref PubMed Scopus (11) Google Scholar , 9 Yang S.-H. Wu C.-Y. Tseng W.-H. et al. Nonintubated laryngomicrosurgery with transnasal humidified rapid-insufflation ventilatory exchange: a case series. J Formos Med Assoc. 2019; 118: 1138-1143 Crossref PubMed Scopus (15) Google Scholar , 10 Huang L. Dharmawardana N. Badenoch A. Ooi E.H. A review of the use of transnasal humidified rapid insufflation ventilatory exchange for patients undergoing surgery in the shared airway setting. J Anesth. 2020; 34: 134-143 Crossref PubMed Scopus (24) Google Scholar Since 2017, most panendoscopies in our centre have been performed with HFNO. Before 2017, panendoscopies were mostly performed with intermittent face mask ventilation (FMV). The objective of this study was to show that HFNO used in 2018 and 2019 during panendoscopies reduced the rate of intraprocedural hypoxaemia (SpO2<90%) compared with spontaneous breathing with FMV as used in 2015 and 2016.