To Tube, or Not to Tube: Comparing Ventilation Techniques in Microlaryngeal Surgery

Authors

Mausumi Syamal MD, Lehigh Valley Health NetworkFollow
Jill Hanisak CRNA, Lehigh Valley Health NetworkFollow
Jennifer E. Macfarlan MPH, Lehigh Valley Health NetworkFollow
Briana Ortega, Department of Surgery, Division of Otolaryngology, University of South Florida, Morsani School of Medicine, Tampa, Florida, U.S.A.
Robert T. Sataloff, Department of Otolaryngology-Head and Neck Surgery and Lankenau Institute for Medical Research, Drexel University College of Medicine, Philadelphia, Pennsylvania, U.S.A.
Michael S. Benninger, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.

Document Type

Article

Publication Date

12-1-2021

Publication Title

The Laryngoscope

E-ISSN

1531-4995

Department(s)

Department of Anesthesiology; Department of Medicine; Department of Surgery; Fellows and Residents; Network Office of Research and Innovation; Division of Otolaryngology

Keywords

Microlaryngeal surgery, THRIVE/Optiflow, apneic oxygenation, high-flow nasal oxygen, ventilation

Abstract

OBJECTIVES/HYPOTHESIS: The objective of this study was to compare ventilation techniques utilized in microlaryngeal surgery. STUDY DESIGN: Retrospective cohort study. METHODS: Two-hundred surgeries performed from May 1, 2018 to March 1, 2020 and stratified as intubated, intermittently intubated (AAIV) or apneic. Patient demographics, comorbidities, anesthetic agents, intraoperative parameters/events, and complications were studied and compared across the three groups using inferential analyses. RESULTS: Median body mass index in the AAIV group was significantly higher (33 vs. 29; P = .0117). Median oxygen nadirs were lower in AAIV cases (81% vs. 91-92%) while CO peak measurements were lower (33 mmHg vs. 48 mmHg) in the fully apneic cohort which were significantly shorter cases (P < .0001). CO peak measurements were comparable between AAIV and intubated cohorts (median 48.5 mmHg vs. 48.0 mmHg). Median apnea times were significantly prolonged by 2-5.5 minutes using nasal cannula and THRIVE/Optiflow in fully apneic cases when compared to no supplementary oxygenation (P = .0013). Systolic blood pressures following insertion of laryngoscope were higher (159.5 vs. 145 mmHg) and postoperative diastolic pressures were lower (68.5 vs. 76.5 mmHg) in fully apneic cases than intubated cases. No differences existed between frequencies of complications. CONCLUSIONS: This study compares intubated, intermittently apneic, and fully apneic surgeries. No statistically significant differences were noted in comorbid conditions. While intraoperative hemodynamic fluctuations were more pronounced in the fully apneic cohort, and oxygenation distributions were lower in the AAIV cohort, no significant differences existed between events and complications. Apneic techniques are as safe and effective as traditional intubation. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2773-2781, 2021.

Volume

131

Issue

12

First Page

2773

Last Page

2781

DOI

10.1002/lary.29750

PubMed ID

34338303

Comments

Presented at the Triological Society Combined Sections Meetings, Coronado Island, CA. January 2022.

Presented at the American Laryngologic Association Meeting at COSM, Austin, TX. May 2019.

Presented at the Vocal Foundation 48th Annual Symposium, Philadelphia, PA. June 2019.

Presented at the International Association of Phonosurgery and Sociedad Argentina de la Voz, Buenos Aires, Argentina. September 2019.

Recommended Citation

Syamal, M., Hanisak, J., Macfarlan, J. E., Ortega, B., Sataloff, R. T., & Benninger, M. S. (2021). To Tube, or Not to Tube: Comparing Ventilation Techniques in Microlaryngeal Surgery. LVHN Scholarly Works. Retrieved from https://scholarlyworks.lvhn.org/research-historical-works/12
DOI: 10.1002/lary.29750