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Transnasal Humidified Rapid-Insufflation Ventilatory Exchange for Elective Laryngeal Surgery During Pregnancy: A Case Report

Kowalczyk, John J. MD*; Carvalho, Brendan MBBCh, FRCA; Collins, Jeremy MBChB, FRCA

doi: 10.1213/XAA.0000000000001098
Case Reports
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Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) maintains oxygenation and blunts the partial pressure of carbon dioxide (Paco2) rise in nonpregnant subjects during apnea. Physiologic changes of pregnancy may attenuate the utility of THRIVE. We present a nulliparous patient at 31 weeks’ gestation undergoing tracheal dilation requiring general anesthesia without intubation utilizing THRIVE. Our data confirms prior reports in nonpregnant patients showing markedly extended time to desaturation. However, Paco2 rise more closely mirrors classic apneic oxygenation in nonobstetric patients. The Paco2 elevation and subsequent acidosis may limit the utility of THRIVE for prolonged apnea in pregnant surgical patients.

From the *Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;

Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.

Accepted for publication August 20, 2019.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Brendan Carvalho, MBBCh, FRCA, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305. Address e-mail to bcarvalho@stanford.edu.

Copyright © 2019 International Anesthesia Research Society
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