Anesthesia for laryngotracheal resection and reconstruction with spontaneous ventilation and high-flow nasal cannula: Cases series

Background and aims: the incidence of subglottic stenosis is increasing, and with this, resection and laryngotracheal reconstruction surgeries have increased. Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) allows apneic oxygenation and ventilation to be achieved using a high-flow nasal cannula. This technique delivers the advantage of providing a non-obstructive surgical field that allows for laryngotracheal reconstruction without airway devices affecting visibility or mobilization. The objective of this study is to describe the use of a total intravenous anesthetic technique and spontaneous ventilation with a high-flow nasal cannula in patients who underwent resection surgery and laryngotracheal reconstruction in a fourth-level institution in Cali-Colombia. Methods: a case series study was conducted. We included 18+ age patients who were taken to resection surgery and laryngotracheal reconstruction with total intravenous anesthesia and high-flow nasal cannula from June 2019 to November 2020. Patients with subglottic stenosis due to diagnosis of Covid-19 and prolonged intubation were excluded. In the statistical analysis, measures of central tendency and dispersion were used for the quantitative variables, according to their normality distribution verified with the Shapiro-Wilk test. Qualitative variables were presented as proportions. Results: 12 patients were included, 9 were men, and the median age was 42 years. Most of the patients were ASA II-III. Half of the surgeries were elective, and the other half were emergency surgeries. Arterial gases were measured before the incision, in the intraoperative and immediate postoperative period, we found hypercapnia in 11, 9, and 8 patients, respectively. In all patients, the PaO2/FiO2 ratio was > 200. Conclusions: Using THRIVE with total intravenous anesthesia in resection surgery and laryngotracheal reconstruction allows achieving continuous oxygenation and adequate ventilation without the interference of airway devices in the surgical field.