Voice Research Laboratory, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
Department of Otolaryngology, The Canterbury Hospital, Campsie, New South Wales, Australia.
Laryngoscope. 2023 Mar;133(3):634-639. doi: 10.1002/lary.30271. Epub 2022 Jul 1.
Ventilation using 100% oxygenation creates a risk of fire during laser microlaryngeal surgery (MLS). The purpose of this study is to describe the technique of transnasal high-flow ventilation using laser safe (30%) oxygen conditions, measure the intraoperative real-time laryngeal oxygen concentration, and examine patient saturation status using this technique.
Prospective IRB approved study of patients undergoing tubeless laser MLS using high-flow nasal oxygenation. Delivered oxygen concentration was reduced from 100% to 30% before lasering using an oxygen-air blender then increased to 100% post-laser procedure. Outcome measures included time for laryngeal oxygen concentration to equalize to laser safe levels; time to, methods of and duration of rescue ventilation; and desaturation rates and apnoeic times at both 100% and 30% oxygen deliveries.
Fifty patients were recruited (mean age = 47.4 years). Mean laryngeal oxygen concentration (%) at 100% and 30% deliveries was 98.46 and 31.45, respectively. Mean (SD) of laryngeal oxygen concentration equalization time to 30% (seconds) was 9.4 (3.69). At 30% oxygen delivery desaturation rate was faster and apneic time shorter compared with 100%. Eighteen patients required rescue (jet) ventilation and they had a faster apneic desaturation rate (%/minute) than patients not requiring rescue. Mean (SD) apneic time (minutes) at 30% delivery was 4.56 (2.25) and 4.41 (2.18) in rescue versus non-rescue groups respectively. BMI was the only significant predictor of desaturation rate at 30% oxygen delivery.
It is possible to achieve a safe time window for use of laser during MLS using transnasal humidified high-flow ventilation by delivering 30% oxygen concentration.
4 Laryngoscope, 133:634-639, 2023.
在激光显微喉外科手术（MLS）中使用 100% 氧气通气会增加火灾风险。本研究的目的是描述使用激光安全（30%）氧气条件进行经鼻高流量通气的技术，测量术中实时喉部氧气浓度，并使用该技术检查患者的饱和度状态。
对使用高流量鼻氧进行无管激光 MLS 的患者进行前瞻性 IRB 批准的研究。在激光治疗前，使用氧气-空气混合器将输送的氧气浓度从 100%降低至 30%，然后在激光治疗后增加至 100%。主要观察指标包括：达到激光安全水平的时间、喉内氧气浓度达到平衡的时间、需要进行通气支持的时间、方法和持续时间、100%和 30%氧气输送时的饱和度下降率和呼吸暂停时间。
共招募了 50 名患者（平均年龄 47.4 岁）。在 100%和 30%氧气输送时，喉部氧气浓度的平均值（%）分别为 98.46%和 31.45%。达到 30%氧气浓度的时间为 9.4 秒（SD 为 3.69）。在 30%氧气输送时，饱和度下降率较快，呼吸暂停时间较短。与 100%相比，18 名患者需要进行（喷射）通气支持，并且他们的呼吸暂停饱和度下降率（%/分钟）更快。在 30%氧气输送时，需要通气支持的患者的呼吸暂停时间（分钟）的平均值（SD）为 4.56（2.25），而无需通气支持的患者为 4.41（2.18）。BMI 是 30%氧气输送时饱和度下降率的唯一显著预测因素。
通过输送 30%的氧气浓度，可以在经鼻湿化高流量通气下为 MLS 期间的激光使用提供安全的时间窗口。
4 Laryngoscope, 133:634-639, 2023.
