BACKGROUND:Apnoeic oxygenation using Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) during general anaesthesia prolongs the safe apnoeic period. However, there is a gap of knowledge how THRIVE-induced hyperoxia and hypercapnia impact vital organs. The primary aim of this randomised controlled trial was to characterise oxidative stress and secondary, vital organ function biomarkers during THRIVE compared to mechanical ventilation (MV). METHODS:Thirty adult patients, ASA 1-2, undergoing short laryngeal surgery under general anaesthesia were randomised to THRIVE, FI O2 1.0, 70 L min-1 during apnoea or mechanical ventilation. Blood biomarkers for oxidative stress, malondialdehyde and TAC, and vital organ function were collected (A) preoperatively, (B) at procedure completion and (C) at PACU discharge. RESULTS:Mean apnoea time was 17.9 (4.8) min and intubation to end-of-surgery time was 28.1 (12.8) min in the THRIVE and MV group respectively. Malondialdehyde increased from 11.2 (3.1) to 12.7 (3.1) µM (p=0.02) and from 9.5 (2.2) to 11.6 (2.6) µM (p=0.003) (A to C) in the THRIVE and MV group, respectively. S100B increased from 0.05 (0.02) to 0.06 (0.02) µg L-1 (p=0.005) (A to C) in the THRIVE group. No increase in TAC, CRP, leukocyte count, troponin-T, NTproBNP, creatinine, eGFR-crea or NSE was demonstrated during THRIVE. CONCLUSION: While THRIVE and MV was associated with increased oxidative stress we found no change in cardiac, inflammation or kidney biomarkers during THRIVE. Further evaluation of stress and inflammatory response and cerebral and cardiac function during THRIVE is needed. This article is protected by copyright. All rights reserved.
RCT Entities:
BACKGROUND: Apnoeic oxygenation using Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) during general anaesthesia prolongs the safe apnoeic period. However, there is a gap of knowledge how THRIVE-induced hyperoxia and hypercapnia impact vital organs. The primary aim of this randomised controlled trial was to characterise oxidative stress and secondary, vital organ function biomarkers during THRIVE compared to mechanical ventilation (MV). METHODS: Thirty adult patients, ASA 1-2, undergoing short laryngeal surgery under general anaesthesia were randomised to THRIVE, FI O2 1.0, 70 L min-1 during apnoea or mechanical ventilation. Blood biomarkers for oxidative stress, malondialdehyde and TAC, and vital organ function were collected (A) preoperatively, (B) at procedure completion and (C) at PACU discharge. RESULTS: Mean apnoea time was 17.9 (4.8) min and intubation to end-of-surgery time was 28.1 (12.8) min in the THRIVE and MV group respectively. Malondialdehyde increased from 11.2 (3.1) to 12.7 (3.1) µM (p=0.02) and from 9.5 (2.2) to 11.6 (2.6) µM (p=0.003) (A to C) in the THRIVE and MV group, respectively. S100B increased from 0.05 (0.02) to 0.06 (0.02) µg L-1 (p=0.005) (A to C) in the THRIVE group. No increase in TAC, CRP, leukocyte count, troponin-T, NTproBNP, creatinine, eGFR-crea or NSE was demonstrated during THRIVE. CONCLUSION: While THRIVE and MV was associated with increased oxidative stress we found no change in cardiac, inflammation or kidney biomarkers during THRIVE. Further evaluation of stress and inflammatory response and cerebral and cardiac function during THRIVE is needed. This article is protected by copyright. All rights reserved.
Authors: Jin Qiu; Mian Xie; Jie Chen; Bing Chen; Yuanjing Chen; Xiwen Zhu; Hui Lin; Tao Zhu; Guangyou Duan; He Huang Journal: Front Med (Lausanne) Date: 2022-03-03