Background: Juvenile-onset recurrent respiratory papillomatosis (JORRP) is a severe pediatric condition requiring frequent surgical interventions to maintain airway patency. Managing oxygenation during tubeless anesthesia for these surgeries poses significant challenges. In 2021, our center introduced transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) as a novel method for airway management in JORRP surgeries. This study evaluated the impact of THRIVE on perioperative outcomes in pediatric JORRP surgeries. Methods: This was a retrospective study of 122 pediatric JORRP surgical cases carried out at a tertiary center. Patients who underwent surgery prior to the implementation of THRIVE served as the control group (pre-THRIVE), while those treated after its introduction served as the intervention group (post-THRIVE), with 61 patients in each group. Perioperative data, including surgery and anesthesia parameters and extubation frequency were collected. Results: A total of 122 patients were included. Baseline characteristics were comparable between groups. After the introduction of THRIVE, the median number of extubations significantly decreased from a median 3 in the pre-THRIVE group to 1 in the post-THRIVE group (P <0.001). Minimum intraoperative SpO2 levels were significantly higher in the post-THRIVE group (98% vs 85%, P <0.001). Surgery duration was reduced from 41 minutes to 35.5 minutes (P =0.003), and anesthesia duration decreased from 67 minutes to 58.5 minutes (P =0.016). No significant differences were observed in PACU stay length or complications between the groups. Conclusion: The implementation of THRIVE in pediatric JORRP enhances intraoperative efficiency and safety. Further research is warranted to assess its long-term effect.