Improved Tubeless Airway Management in JORRP Surgery: Comparative Analysis of Pre- and Post-THRIVE Implementation

Guiyu Lei,1 Siliu Yang,2 Lili Wu,1 Yue Yin,1 Chunhua Xi,1 Yang Xiao,3 Guyan Wang1 1Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People’s Republic of China; 2Department of Anesthesiology, Beijing Dongcheng Maternal and Child Health Care Hospital, Beijing, 100007, People’s Republic of China; 3Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otolaryngology, Head and Neck Surgery (Ministry of Education of China), Beijing, 100730, People’s Republic of ChinaCorrespondence: Guyan Wang, Department of Anaesthesiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang, Dongcheng District, Beijing, 100730, People’s Republic of China, Tel +86 13910985139, Email [email protected]: Juvenile-onset recurrent respiratory papillomatosis (JORRP) is a severe pediatric condition requiring frequent surgical interventions to maintain airway patency. Managing oxygenation during tubeless anesthesia for these surgeries poses significant challenges. In 2021, our center introduced transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) as a novel method for airway management in JORRP surgeries. This study evaluated the impact of THRIVE on perioperative outcomes in pediatric JORRP surgeries.Methods: This was a retrospective study of 122 pediatric JORRP surgical cases carried out at a tertiary center. Patients who underwent surgery prior to the implementation of THRIVE served as the control group (pre-THRIVE), while those treated after its introduction served as the intervention group (post-THRIVE), with 61 patients in each group. Perioperative data, including surgery and anesthesia parameters and extubation frequency were collected.Results: A total of 122 patients were included. Baseline characteristics were comparable between groups. After the introduction of THRIVE, the median number of extubations significantly decreased from a median 3 in the pre-THRIVE group to 1 in the post-THRIVE group (P < 0.001). Minimum intraoperative SpO2 levels were significantly higher in the post-THRIVE group (98% vs 85%, P < 0.001). Surgery duration was reduced from 41 minutes to 35.5 minutes (P =0.003), and anesthesia duration decreased from 67 minutes to 58.5 minutes (P =0.016). No significant differences were observed in PACU stay length or complications between the groups.Conclusion: The implementation of THRIVE in pediatric JORRP enhances intraoperative efficiency and safety. Further research is warranted to assess its long-term effect.Keywords: THRIVE, JORRP, tubeless anesthesia, airway management, SpO2