New Suggested Enhancing Safe Apneic Time in Edentulous Elderly: A Comparison of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange and Facemask

BACKGROUND: Edentulous elderly patients often face challenges in airway management and are susceptible to hypoxemia. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) provides high-flow nasal oxygenation, potentially extending safe apneic time (SAT). This study compared the efficacy of THRIVE versus facemask ventilation in improving oxygenation and extending SAT in edentulous elderly patients. MATERIAL/METHODS: Patients with more than 10 missing teeth and who were over 65 years old were randomly assigned to the facemask group (Group M, n=25) or the THRIVE group (Group T, n=25). Patients in Group M were pre-oxygenated with a facemask (6 L/min, FiO(2) 100%), while patients in Group T were pre-oxygenated with their mouths closed via THRIVE (30 L/min, FiO(2) 100%). After anesthesia induction, patients in Group M were ventilated with pressure-controlled ventilation. In Group T, the patient’s mouth was kept closed, and the flow rate was adjusted to 70 L/min. Four min after cisatracurium administration, ventilation was stopped in Group M while Group T continued to receive oxygen (70 L/min, FiO(2) 100%). The primary outcome was SAT, which was attained at 4 min after injection of cisatracurium and ended when SpO(2) decreased to 95% or when apneic time reached 480 s. A secondary outcome was the reoxygenation time, defined as the time from the beginning of mechanical ventilation to the time when SpO(2) 98% was reached. RESULTS: An SAT of 480 s was reached by all patients in Group T, but by only 6 patients in Group M (P<0.05). Compared with Group M, the reoxygenation time in Group T was significantly shorter (P<0.05). CONCLUSIONS: As compared to facemask, THRIVE can extend the SAT, improve oxygenation, and reduce reoxygenation time.