An Observational Study to Assess the Role of Transnasal Humidified Rapid Insufflation Ventilatory Exchange with Target Controlled Infusion as Sole Airway Management Strategy During Endoscopic Retrograde Cholangiopancreatography Under General Anaesthesia.

Abstract

Endoscopic retrograde cholangiopancreatography is frequently performed under general anaesthesia with endotracheal intubation due to increased risk of hypoxemia under deep sedation, however intubation carries its own risks and is associated with longer induction times. Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is a promising noninvasive technique that reduces the risk of hypoxia while avoiding risks associated with endotracheal intubation. This prospective observational study was conducted to assess the efficacy of THRIVE combined with Target-Controlled Infusion (TCI) of propofol as a sole airway management strategy in 56 adult patients undergoing elective ERCP under GA. THRIVE oxygen was delivered via nasal cannula at 20–25 L/min for preoxygenation, increased to 30–70 L/min post-induction. General anaesthesia was maintained with TCI- propofol using BIS titrated to 40–60. In summary, combination of THRIVE with TCI-propofol provided safe approach to airway management for ERCP under GA, minimizing the need for endotracheal intubation while maintaining oxygenation and ventilation.