# Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) for the Operative Management of Retrograde Cricopharyngeus Dysfunction

## TL;DR

THRIVE is a safe method for apneic oxygenation during surgery for retrograde cricopharyngeus dysfunction, though some patients may need backup ventilation.

## Contribution

Demonstrates THRIVE's feasibility for CPBI in RCPD patients under general anesthesia.

## Key findings

- 82% of patients maintained oxygenation during THRIVE-assisted CPBI.
- Higher BMI predicted failure to maintain oxygenation.
- Average increase in end-tidal CO2 was 1.14 mm Hg/min.

## Abstract

Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is a method of apneic oxygenation gaining popularity in upper aerodigestive surgery. Retrograde cricopharyngeus muscle dysfunction (RCPD) is characterized by the inability to belch, managed by intraoperative injection of botulinum toxin to the cricopharyngeus muscle (CPBI), often performed under general anesthesia with endotracheal intubation. We sought to assess the safety and efficacy of THRIVE when performing CPBI for RCPD.

We conducted a retrospective review of adult RCPD patients undergoing CPBI under general anesthesia with THRIVE.

The study was conducted at both the University of Texas Health Science Centers in Houston and San Antonio over a 5‐month period from June 2023 to November 2023.

Patients were placed under general anesthesia using THRIVE. CPBI was performed. Demographic, clinical, and anesthesiologic data were collected and analyzed.

In total, 32/39 (82%) were able to maintain oxygenation throughout the procedure. Mean (standard deviation) time from induction to paralytic reversal was 7.8 (3.3) minutes. Time from induction to return of spontaneous breathing was 9.9 (3.2) minutes. Excluding seven patients who required “rescue” bag‐mask ventilation due to failure to maintain oxygenation, the median oxygen saturation nadir was 97.7% (range 92%‐100%). The average increase in end‐tidal CO2 level (EtCO2) was 1.14 mm Hg/min. Body mass index (BMI) significantly predicted failure to maintain oxygenation on binary logistic regression (coefficient 0.239, P = .010).

THRIVE is a feasible means of apneic oxygenation when performing operative CPBI for patients with RCPD, although the need for “rescue” ventilation may occur at a higher rate in comparison to existing literature for laryngotracheal surgery.

IV.