Apneic anesthesia with THRIVE for pediatric bronchial foreign body removal: A case series

Anesthesia for impacted tracheobronchial foreign body (FB) removal in pediatrics is challenging owing to shared airway, need of tubeless apneic anesthesia, and higher risk of airway complications. Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) has unique applications for apneic anesthesia. The authors describe two pediatric cases of impacted lower bronchial FB that were difficult to retrieve and required long procedure time. They were done successfully under apneic anesthesia using THRIVE that provided intermittent total apnea of 58 and 62 min, respectively, with single-continuous apnea time of 13–18 min. THRIVE facilitated the procedure by providing a safe long apnea time without desaturation and with permissible increase in PaCo(2) while maintaining hemodynamic parameters and oxygenation.