Abstract:Objective To observe the application effect of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) during intravenous anesthesia for hysteroscopy in obese patients, as well as the incidence of adverse reactions. Methods A total of 100 obese patients undergoing elective hysteroscopy at the Affiliated Hospital of Nanjing University of Chinese Medicine from January to December 2024 were selected. They were randomly divided into the observation group and the control group (n=50, each) using a random number table method. The observation group received THRIVE, while the control group was given conventional nasal cannula oxygen inhalation. Both groups were anesthetized with intravenous injection of propofol (1.5-2.5 mg/kg) combined with intravenous injection of sufentanil (0.1 μg/kg). General vital signs and arterial blood gas indicators were compared between the two groups at three time points: before anesthesia (T0), 5 minutes after anesthesia (T1), and 5 minutes after awakening (T2). The incidence and management of hypoxia-related adverse events, main anesthetic indicators (awakening time, dosages of propofol and sufentanil), and occurrence of adverse reactions were recorded. Results At T1, the mean arterial pressure and heart rate in the observation group were lower than those in the control group, while the saturation of peripheral oxygen was higher (P<0.05) ; there was no statistically significant difference in vital signs between the two groups at other time points (P>0.05). The incidence of hypoxia-related adverse events in the observation group was lower than that in the control group (subclinical respiratory depression: 12.0% vs 44.0%, χ²=12.689, P<0.01; hypoxia: 2.0% vs 18.0%, χ²=7.111, P= 0.008). Additionally, the concurrent usage rate of open airway techniques and face masks in the observation group were also lower than those in the control group (12.0% vs 68.0%, χ²=32.667, P<0.01; 0 vs 12.0%, χ²=12.636, P<0.01). At T2, the arterial partial pressure of oxygen and arterial oxygen saturation in the observation group were significantly higher; there was no statistically significant difference in pH value or arterial partial pressure of carbon dioxide between the two groups (P>0.05). No significant difference in arterial blood gas indicators was found between the two groups at other time points (P>0.05). There was no statistically significant difference in the total incidence of adverse reactions between the control group and the observation group [10.0% (5/50) vs 10.0% (5/50), χ²=0, P=1.000]. Conclusion In obese patients undergoing hysteroscopic surgey, THRIVE can effectively prevent hypoxia-related adverse events during anesthesia and reduce the need for airway support.