Faculty, Staff and Student Publications
Language
English
Publication Date
1-1-2025
Journal
OTO Open
DOI
10.1002/oto2.70173
PMID
41142175
PMCID
PMC12550269
PubMedCentral® Posted Date
10-23-2025
PubMedCentral® Full Text Version
Post-print
Abstract
Objective: Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is a method of apneic oxygenation gaining popularity in upper aerodigestive surgery. Retrograde cricopharyngeus muscle dysfunction (RCPD) is characterized by the inability to belch, managed by intraoperative injection of botulinum toxin to the cricopharyngeus muscle (CPBI), often performed under general anesthesia with endotracheal intubation. We sought to assess the safety and efficacy of THRIVE when performing CPBI for RCPD.
Study design: We conducted a retrospective review of adult RCPD patients undergoing CPBI under general anesthesia with THRIVE.
Setting: The study was conducted at both the University of Texas Health Science Centers in Houston and San Antonio over a 5-month period from June 2023 to November 2023.
Methods: Patients were placed under general anesthesia using THRIVE. CPBI was performed. Demographic, clinical, and anesthesiologic data were collected and analyzed.
Results: In total, 32/39 (82%) were able to maintain oxygenation throughout the procedure. Mean (standard deviation) time from induction to paralytic reversal was 7.8 (3.3) minutes. Time from induction to return of spontaneous breathing was 9.9 (3.2) minutes. Excluding seven patients who required "rescue" bag-mask ventilation due to failure to maintain oxygenation, the median oxygen saturation nadir was 97.7% (range 92%-100%). The average increase in end-tidal CO2 level (EtCO2) was 1.14 mm Hg/min. Body mass index (BMI) significantly predicted failure to maintain oxygenation on binary logistic regression (coefficient 0.239, P = .010).
Conclusion: THRIVE is a feasible means of apneic oxygenation when performing operative CPBI for patients with RCPD, although the need for "rescue" ventilation may occur at a higher rate in comparison to existing literature for laryngotracheal surgery.
Level of evidence: IV.
Keywords
apneic oxygenation, esophagus, high‐flow nasal oxygen, RCPD, THRIVE
Published Open-Access
yes
Recommended Citation
Leming, Amy B; Vance, Dylan G; Tritter, Andrew G; et al., "Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) for the Operative Management of Retrograde Cricopharyngeus Dysfunction" (2025). Faculty, Staff and Student Publications. 4054.
https://digitalcommons.library.tmc.edu/uthmed_docs/4054