Use of trans-nasal humidified rapid insufflation ventilatory exchange in a post-pneumonectomy patient undergoing injection laryngoplasty: a case report

Post-pneumonectomy patients present significant anesthetic challenges because of severely reduced pulmonary reserve, altered ventilation-perfusion relationships, and limited tolerance to apnea. Airway procedures requiring a shared field further complicate management. We describe the perioperative management of a 40 years old patient with prior left pneumonectomy who presented with hoarseness of voice secondary to left recurrent laryngeal nerve palsy caused by tumor encasement. The patient underwent injection laryngoplasty using filler material under general anesthesia with trans-nasal humidified rapid insufflation ventilatory exchange (THRIVE) as the primary oxygenation strategy. THRIVE provided effective oxygenation, a tubeless surgical field, and avoidance of positive pressure ventilation in a single-lung patient. This report highlights the physiological considerations in post-pneumonectomy patients and discusses the advantages and limitations of THRIVE compared with microlaryngeal tube ventilation, jet ventilation, and conventional apneic oxygenation.