• Sunil Rajan, Nandhini Joseph, Pulak Tosh, Dilesh Kadapamannil, Jerry Paul, and Lakshmi Kumar.
• Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
• Indian J Anaesth. 2018 Mar 1; 62 (3): 202-207.

Background And AimsTransnasal humidified rapid-insufflation ventilatory exchange (THRIVE) during apnoea has shown to delay desaturation. The primary objective was to compare time to desaturate to <90% during apnoea with THRIVE versus traditional preoxygenation followed by apnoeic oxygenation.MethodsThis prospective, randomised, single-blinded study was conducted in 10 adult patients presenting for direct laryngoscopy under general anaesthesia without endotracheal intubation. Group P patients were preoxygenated with 100% oxygen, and in Group H, high-flow humidified oxygen was delivered using nasal cannula for 3 min. After induction and neuromuscular blockade, time to desaturate to 90%, while receiving apnoeic oxygenation, was noted. Chi-square test and Mann-Whitney tests were used.ResultsGroup H had a significantly longer apnoea time as compared to Group P (796.00 ± 43.36 vs. 444.00 ± 52.56 s). All patients in Group H continued to have nearly 100% saturation even at 12 min of apnoea. However, in Group P, 80% of patients desaturated to <90% after 6 min of apnoea. Baseline blood gases, that following preoxygenation and at 3 min of apnoea time were comparable in both groups. At 6 min, Group H had a significantly higher PaO2 (295.20 ± 122.26 vs. 135.00 ± 116.78) and PaCO2 (69.46 ± 7.15 vs. 59.00 ± 4.64). Group H continued to have a PaO2 of >200 mmHg even at 12 min of apnoea with a significant rise in PaCO2 along with fall in pH after 6 min.ConclusionDuring apnoeic periods time to desaturate to <90% was significantly prolonged with use of THRIVE.

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