Therapeutics and clinical risk management · 2026
Transnasal Humidified Rapid-Insufflation Ventilatory Exchange versus Oropharyngeal Airway-Assisted Face-Mask Ventilation for Gastric Insufflation During Induction of General Anesthesia in Patients at High Risk for Obstructive Sleep Apnea.
Клинический случайКлиническое исследованиеСтатьяНазвание и аннотация: Перевод в очереди
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Jia Zhe, Xu Yangfei, Zhang Can, Jiang Huifang, Han Yingying, Yuan Xiaohong, Wang Hongwei, Xie Kangjie
Аннотация
PURPOSE: Obstructive sleep apnea (OSA) is an independent risk factor for gastric insufflation during the induction of general anesthesia. We aimed to compare the impact of oropharyngeal airway-assisted face-mask ventilation and transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) on gastric insufflation in patients with high-risk OSA.
PATIENTS AND METHODS: Patients at high risk for OSA scheduled for elective major abdominal surgery under general anesthesia were randomized 1:1 to either Group T (THRIVE throughout induction) or Group M (face-mask preoxygenation followed by oropharyngeal airway-assisted pressure-controlled ventilation). Gastric antrum ultrasonography was performed at baseline (T1), after preoxygenation (T2), and post-intubation (T4) to assess changes of antral cross-sectional area (CSAa). Arterial blood gases were analyzed at T1, T2, after induction during ventilation/apnea (T3), and T4. Adverse events and patient comfort were recorded. The primary outcome was the incidence of gastric insufflation at T4. Secondary outcomes included CSAa percentage change, oxygenation and arterial blood gas variables, adverse events, and patient comfort.
RESULTS: Of 100 randomized patients, 94 completed the study (47 per group). Group T demonstrated a significantly lower incidence of gastric insufflation post-intubation compared to Group M (23.4% vs 44.7%; P = 0.030) and a smaller median percentage increase in antral cross-sectional area (7.62% vs 13.24%; P = 0.070). THRIVE provided superior preoxygenation (higher PaO2 at T2, P < 0.001). During apnea (T3-T4), Group T maintained adequate oxygenation (SpO2 >92%) without mechanical ventilation but developed mild hypercapnia, which was expected to improve following continued mechanical ventilation after intubation. Adverse event rates were non-significant (P = 1.000). Patient comfort scores were significantly higher in Group T (P < 0.001).
CONCLUSION: In patients at high risk for OSA, THRIVE reduces the incidence of gastric insufflation during induction compared with oropharyngeal airway-assisted face-mask ventilation. THRIVE improves preoxygenation and patient comfort. Oxygenation was maintained during apnea, with a transient increase in PaCO2 observed after intubation.
PATIENTS AND METHODS: Patients at high risk for OSA scheduled for elective major abdominal surgery under general anesthesia were randomized 1:1 to either Group T (THRIVE throughout induction) or Group M (face-mask preoxygenation followed by oropharyngeal airway-assisted pressure-controlled ventilation). Gastric antrum ultrasonography was performed at baseline (T1), after preoxygenation (T2), and post-intubation (T4) to assess changes of antral cross-sectional area (CSAa). Arterial blood gases were analyzed at T1, T2, after induction during ventilation/apnea (T3), and T4. Adverse events and patient comfort were recorded. The primary outcome was the incidence of gastric insufflation at T4. Secondary outcomes included CSAa percentage change, oxygenation and arterial blood gas variables, adverse events, and patient comfort.
RESULTS: Of 100 randomized patients, 94 completed the study (47 per group). Group T demonstrated a significantly lower incidence of gastric insufflation post-intubation compared to Group M (23.4% vs 44.7%; P = 0.030) and a smaller median percentage increase in antral cross-sectional area (7.62% vs 13.24%; P = 0.070). THRIVE provided superior preoxygenation (higher PaO2 at T2, P < 0.001). During apnea (T3-T4), Group T maintained adequate oxygenation (SpO2 >92%) without mechanical ventilation but developed mild hypercapnia, which was expected to improve following continued mechanical ventilation after intubation. Adverse event rates were non-significant (P = 1.000). Patient comfort scores were significantly higher in Group T (P < 0.001).
CONCLUSION: In patients at high risk for OSA, THRIVE reduces the incidence of gastric insufflation during induction compared with oropharyngeal airway-assisted face-mask ventilation. THRIVE improves preoxygenation and patient comfort. Oxygenation was maintained during apnea, with a transient increase in PaCO2 observed after intubation.