D. **STRIV-Hi technique**

**S**pon**T**aneous **R**espiration using **I**ntra **V**enous anesthesia & High flow nasal oxygenation. By using this way of anesthesia, we apply the concept of spontaneous ventilation according stepwise Target – Controlled Infusion (TCI Marsh technique) of Propofol applying the formula CP – Ce = 1.

Cp = the expected Propofol concentration at the plasma.

Ce = the predicted Propofol effect site concentration.

## **Benefits For all: (Patient, Surgeon, Anesthetist).**

The use of STRIV-Hi technique decreases stress of endotracheal tube on cardio vascular system (CVS), respiratory system. Eventually it decreases post intubation complications. Because of the surgeon & the anesthetist are working at the same site there will be a high risk of affection on the ventilation, oxygenation and loss of airway.

It provides (wider field) for the surgeon & at the same time it can facilitate oxygenation during the induction of anesthesia in cases of severe laryngotracheal

**135**

**Figure 8.** *HFNC in use.*

**Figure 7.**

*Hunsaker Mon-Jet catheter.*

*Airway Management in Head and Neck Pathology DOI: http://dx.doi.org/10.5772/intechopen.94498*

stenosis which cannot be intubated conventionally. Also, it facilitates dynamic airway assessment & prevents risk of barotrauma (compared to jet ventilation).

Duration of surgery: Operation less than 30 minutes so it is not suitable for junior staff both anesthetist and operating surgeon. It leads to CO2 accumulation. It cannot be used in case of complete nasal obstruction, bleeding inside the airway & in case of Infection: opened abscess or COVID 19 patients. Also, not used in morbid

1. Difficult laryngeal exposure because of underlying anatomy which affect on the performance of micro-laryngoscope using rigid laryngoscopy/bronchoscopy. We

may expect a "difficult exposure" per-orally in the following conditions:

**3.4 Limitations of HFNC in MLS surgery**

obesity and predicted difficult airway.

A. Limited neck extension

C. Retrognathia

**3.5 In case of difficult exposure of the larynx**

B. Big tongue/difficult palatal visualization

**Figure 6.** *Jet ventilation probe.*

*Airway Management in Head and Neck Pathology DOI: http://dx.doi.org/10.5772/intechopen.94498*

**Figure 7.** *Hunsaker Mon-Jet catheter.*

*Special Considerations in Human Airway Management*

the perfection of the surgical technique.

catheter with Twin-stream jet ventilator.

of up to 60–80 L/min.

D. **STRIV-Hi technique**

C. **Apneic technique using high flow nasal cannula (HFNC)**

technique) of Propofol applying the formula CP – Ce = 1. Cp = the expected Propofol concentration at the plasma. Ce = the predicted Propofol effect site concentration. **Benefits For all: (Patient, Surgeon, Anesthetist).**

Tracheal jet ventilation is better than supra-glottic jet ventilation [7], because tracheal jet ventilation helps the operating surgeon with less movement of the vocal cords. This is very important while performing phono-microsurgery. Also, it allows for better end-tidal CO2 monitoring. On the other hand, Jet ventilation (supra-glottic, as opposed to subglottic) is safest when used proximally. However, movement of the vocal cords due to jet air will effect on

3.Tracheal Jet ventilation using plastic catheter inside the trachea: for example: Hunsaker Mon-Jet infra-glottic ventilation catheter (**Figure 7**) or tri-lumen

In our center we use this technique in 95% of the benign laryngeal lesion's surgery (**Figure 8**). High flow nasal cannula (HFNC) has been shown beneficial in pre-oxygenation, oxygenation after extubation & in the treatment of respiratory failure and heart failure. Recently HFNC proved to provide a very good oxygenation & ventilation for the patients who performing various upper airway surgeries without the need for the jet ventilation or endotracheal intubation. Delivery of O2 via (HFNC) is an exciting & emerging therapy in acute adult medical practice. Humidified and worm O2 is delivered at flow rate

**S**pon**T**aneous **R**espiration using **I**ntra **V**enous anesthesia & High flow nasal oxygenation. By using this way of anesthesia, we apply the concept of spontaneous ventilation according stepwise Target – Controlled Infusion (TCI Marsh

The use of STRIV-Hi technique decreases stress of endotracheal tube on cardio vascular system (CVS), respiratory system. Eventually it decreases post intubation complications. Because of the surgeon & the anesthetist are working at the same site there will be a high risk of affection on the ventilation, oxygenation and loss of airway. It provides (wider field) for the surgeon & at the same time it can facilitate oxygenation during the induction of anesthesia in cases of severe laryngotracheal

**134**

**Figure 6.**

*Jet ventilation probe.*

**Figure 8.** *HFNC in use.*

stenosis which cannot be intubated conventionally. Also, it facilitates dynamic airway assessment & prevents risk of barotrauma (compared to jet ventilation).
