In the final episode of series 4 of BLA Connections: A Clear Voice, host Natalie Watson is joined by Professor Reza Nouraei, Consultant Laryngologist and Tracheal Surgeon at Queen’s Medical Centre, Nottingham, to discuss how to oxygenate our patients whilst operating on the larynx under general anaesthetic. Prof Nouraei walks us step-by-step through THRIVE and other tubeless ventilation methods.
“You have all the time in the world to put a scope in, as long as it's less than three minutes.”
This quote from Prof David Howard, a global Laryngology pioneer and a friend and mentor to many UK Laryngologists including Prof Nouraei, was an inspiration to search for methods of increasing apnoea time.
THRIVE is essentially a method of ventilating patients who are under general anaesthesia and under conditions of muscle paralysis (i.e. apnoea), by filling the upper airways with oxygen and by activating a ventilatory exchange process which increases the time to desaturation.
As well as explaining the functions and indications for THRIVE, Prof Nouraei shares his tips and insights for using the procedure successfully, including which patients and conditions might not be suitable for it. We also discuss other ventilation strategies and new airway management tools for further improving them.
To ensure that patients with acutely compromised airways are managed safely, it is vital to understand the anatomy of laryngoscopy and to appreciate how the sharp angle between the lips and the larynx is converted into a straight line. This enables the laryngologist to create safe access corridors for oxygenation and for shared-airway surgery after the patient has been anaesthetised and has been rendered apnoeic.
Apnoeic ventilation has been a major game changer for our specialty, as well, more broadly, for the care of patients with complex and compromised airways whom, as laryngologists, we are regularly called upon to support.
For more expert insight into all things laryngology, please do look back at other episodes in this series, including the management and patient journey of airway stenosis, persistent throat symptoms, and the ageing voice. And if you have a topic you think we should cover next series, do let us know!
*Please note a declaration of interest: Prof. Reza Nouraei declares that he has received research and consultancy support from Fisher and Paykel.
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