Successful Application of Transnasal Humidified Rapid-Insufflation Ventilatory Exchange in a Case of Subglottic Stenosis.

We widely employ microlaryngeal surgery to treat diverse oropharyngeal and laryngeal conditions, but it presents challenges to shared airway management. This case report addresses the limitations of conventional techniques, such as tracheal intubation and jet ventilation, and explores the emerging interest in transnasal humidified rapid insufflation ventilatory exchange (THRIVE). While THRIVE offers advantages such as enhanced visualization and reduced airway trauma, its application is limited by the duration of apnea, with the literature referring to a maximum of 30 minutes of apnea. We present the successful application of THRIVE as the primary airway management technique in a patient undergoing a 55-minute dilation procedure for subglottic stenosis. Successful oxygenation was achieved, creating a tubeless field and improving visibility. The patient maintained oxygen saturation above 98%, demonstrating the effectiveness of THRIVE in managing prolonged apnea. Remarkably, intentional ventilation via a face mask at specific moments allowed extended apneic oxygenation without harmful carbon dioxide levels. This report complies with the growing evidence supporting the efficacy of THRIVE in providing extended apnea for tubeless surgery. The success demonstrated in our case highlights the feasibility and effectiveness of THRIVE in situations demanding prolonged apnea and complex airway management.

Pulmonary biological glue embolism after endoscopic repair of gastric varices - A case report.

Cyanoacrylate injection is widely used to treat hemorrhagic gastric varices. A pulmonary glue embolism is an unusual but potentially fatal complication. We present a case of a 51-year-old man with a history of alcoholic hepatic cirrhosis Child-Pugh B, who had an acute pulmonary embolism with sudden cardiorespiratory collapse due to biological glue injection used for the emergent repair of bleeding gastric varices. After the restoration of respiratory and hemodynamic parameters, he was admitted to the intensive care unit and the pulmonary biological glue emboli were documented with computed tomography scan. A high index of suspicion for this entity is essential in patients submitted to endoscopic sclerotherapy. Some might be asymptomatic or mildly symptomatic, while others might present with cardiorespiratory collapse.