Tracheal Extubation Under Deep Anesthesia Using Transnasal Humidified Rapid Insufflation Ventilatory Exchange vs. Awake Extubation: An Open-Labeled Randomized Controlled Trial

Frontiers in Medicine

article

Jin Qiu¹  Mian Xie²  Jie Chen¹  Bing Chen¹  Yuanjing Chen¹  Xiwen Zhu¹  Hui Lin³  Tao Zhu⁴  Guangyou Duan¹  He Huang¹ 

[1] Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University;Chongqing Traditional Chinese Medicine Hospital;Department of Statistics, Army Medical University;Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University

关键词: tracheal extubation;    hypoxia;    THRIVE;    deep anesthesia;    awake extubation;   

DOI  :  10.3389/fmed.2022.810366

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background Tracheal extubation can be associated with several complications, including desaturation, agitation, hypertension, and tachycardia. We hypothesize that the use of transnasal humidified rapid insufflation ventilator exchange (THRIVE) immediately after extubation under deep anesthesia reduces the incidence of these adverse events. Methods One hundred patients who underwent elective abdominal surgery under general anesthesia were randomly assigned to undergo tracheal extubation under deep anesthesia employing THRIVE (THRIVE group) or awake extubation (CONTROL group). The primary outcome was the incidence of experiencing desaturation (SpO 2 < 90%) at any time during emergence from anesthesia. Secondary outcomes included variations in heart rate and blood pressure, comfort level, bucking, and agitation. Results The THRIVE group showed a lower incidence of desaturation than the CONTROL group (12 vs. 54%, OR = 0.22 [95% CI, 0.10–0.49], P < 0.001). Less patients in the THRIVE group experienced a 20% (or more) increase in mean arterial pressure (4 vs. 26%, OR = 0.15 [95% CI, 0.04–0.65], P = 0.002). THRIVE patients did not suffer from agitation or bucking, while in the CONTROL group agitation and bucking occurred in 22 and 58% of the patients, respectively. Additionally, the THRIVE group showed a lower incidence of uncomfortable experience than the CONTROL group (8 vs. 36%, OR = 0.22 [95% CI, 0.08–0.61], P = 0.001). Conclusion Tracheal extubation under deep anesthesia using THRIVE decreases the incidence of desaturation and adverse haemodynamic events and increases patient satisfaction. Extubation under deep anesthesia using THRIVE might be an alternative strategy in selected patient populations.

【 授权许可】

CC BY