Anesthetic considerations for bronchoscopic procedures: a narrative review based on the Cleveland Clinic experience

Galway, Ursula; Zura, Andrew; Khanna, Sandeep; Wang, Mi; Turan, Alparslan; Ruetzler, Kurt

doi:10.21037/jtd.2019.07.29

Cited by 28 publications

(26 citation statements)

References 86 publications

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“…Monitored anesthesia care (MAC) as moderate sedation was performed in basic and some advanced bronchoscope procedures 11 . By maintaining spontaneous breathing, without the need for LMA or intubation, MAC can meet surgical needs and alleviates the patient's discomfort 1 . The key of MAC in BI is how to maintain the patient's oxygenation in the open airway and ensure the feasibility of procedures meanwhile.…”

Section: Discussionmentioning

confidence: 99%

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High frequency jet ventilation through mask contribute to oxygen therapy in patients undergoing bronchoscopic intervention under deep sedation

Yang

Wang

Hou

et al. 2020

Preprint

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Background: High frequency jet ventilation (HFJV) is an open ventilating technique to maintain ventilation for emergency or difficult airway. However, it is unclear whether jet ventilation or conventional oxygen therapy (COT) is more effectively and safely to maintain adequate oxygenation in patients with airway stenosis during bronchoscopic intervention (BI) under deep sedation.Methods: A prospective randomized cohort study was conducted to compare HFJV with normal frequency jet ventilation (NFJV) and COT (high flow oxygen) in oxygen supplementation during BI under deep sedation from March 2020 to August 2020. Patients receiving BI under deep sedation were randomly divided into 3 parallel groups of 50 patients each: the COT group (FiO21.0, 12 L/min), the NFJV Group (FiO2 1.0, driving pressure 0.1MPa, respiratory rate (RR) 15bpm) and HFJV Group (FiO2 1.0, driving pressure 0.1MPa, RR 1200bpm). SpO2, MBP and HR were recorded during the whole procedure. Arterial blood gas was examined and recorded at 15 minutes after initiation of procedure. Procedure duration, dose of anesthetics and adverse events during BI in the three groups were also recorded.Results: A total of 161 patients were enrolled with 11 patients excluded. Clinical characteristics were similar among the three groups. PaO2 of HFJV group was significantly higher than that of COT and NFJV group (P<0.001). PaO2 was significantly correlated with ventilation mode (P<0.001), BMI (P=0.019) and procedure duration (P=0.001). Multiple linear regression showed that only BMI and procedure duration were independent influencing factors of arterial blood gas PaO2 (P=0.040, P=0.002). The location of airway lesions and severity of airway stenosis were no statistical correlation with PaCO2 and PaO2.Conclusions: HFJV can effectively and safely improve intra-operative PaO2 in patients with airway stenosis during BI in deep sedation, and doesn’t increase intra-operative PaCO2 and the risk of hypercapnia. The location of airway lesions and severity of airway stenosis may not affect oxygenation maintain during basic and some advanced BI.Trial registration: Chinese Clinical Trial Registry. Registration number, ChiCTR2000031110, registered on March 22, 2020.

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Section: Discussionmentioning

confidence: 99%

“…Bronchoscopic intervention (BI) has become the preferred method for the diagnosis and treatment of airway lesions. It plays an important role in improving the patient's quality of life, especially by relieving airway obstructions 1 . Different procedures require different methods of anesthesia and different airway management.…”

Section: Introductionmentioning

confidence: 99%

High frequency jet ventilation through mask contribute to oxygen therapy in patients undergoing bronchoscopic intervention under deep sedation

Yang

Wang

Hou

et al. 2020

Preprint

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“…Although SGA(supraglottic airway) insertion itself may not necessitate muscle paralysis, paralyzed vocal cords facilitates bronchoscopy in adduction position. Furthermore, muscle paralysis could attenuate the risk of patient's coughing and movements during the operation, as well as lower the chest wall resistance and reduce inspiratory pressures needed to achieve satisfactory tidal volumes [21][22][23][24] . At the beginning, we also did not dare to use muscle relaxants, but with the improvement of anesthesia equipments, visual technology, and anesthesia skills, we began to experiment with muscle relaxants.…”

Section: Discussionmentioning

confidence: 99%

Anesthesia Management in Patients With Central Airway Stenosis Undergoing Bronchoscopy Treatments - Safety Application of Muscle Relaxants and the Traditional Low-frequency Ventilation : A Retrospective Observational Study

et al. 2020

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Background: Bronchoscopy treatments of central airway stenosis (CAO) under general anesthesia are high-risky procedures, and posing a giant challenge to the anesthesiologists. The aim of this research was to estimate the safety application of muscle relaxants and the traditional Low-frequency ventilation in patients with central airway stenosis undergoing bronchoscopy treatments under general anesthesia by summarizing our clinical experience.Methods: Clinical data of 375 patients with CAO who underwent urgent endoscopic treatments from January 2016 to October 2019 were retrospectively reviewed. The use ratio of skeletal muscle relaxants, dose of fentanyl and skeletal muscle relaxants used between rigid bronchoscopy compared with flexible bronchoscopy therapy, the incidence of perioperative adverse events, adequacy of ventilation and gas exchange, post-operative recovery and risk factors for postoperative ICU admission were evaluated. Results: There was a high usage rate (96.5%) of skeletal muscle relaxants in patients with CAO who underwent either flexible bronchoscopy or rigid bronchoscopy therapy and there is a higher dosage of analgesic and skeletal muscle relaxants used in rigid bronchoscopy compared with flexible bronchoscopy therapy. This procedure had a low incidence of perioperative adverse events, with no significant difference between flexible bronchoscopy and rigid bronchoscopy therapy. Sufficient ventilation was successfully established using the traditional Low-frequency ventilation both in flexible and rigid bronchoscopy group. There was a low mortality (0.8%) during the post-operative recovery, and the higher grade of ASA and obvious dyspnea or orthopnea were the independent risk factors for postoperative ICU admission. Conclusion: The use of proper dosage of muscle relaxants is indispensable and safe in patients with CAO undergoing bronchoscopy treatments and the traditional Low-frequency ventilation also can be used in this procedure safely.

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“…Although SGA (supraglottic airway) insertion itself may not necessitate muscle paralysis, paralyzed vocal cords facilitates bronchoscopy in adduction position. Furthermore, muscle paralysis could attenuate the risk of patient's coughing and movements during the operation, as well as lower the chest wall resistance and reduce inspiratory pressures needed to achieve satisfactory tidal volumes [23][24][25][26] . At the beginning, we also did not dare to use muscle relaxants, but with the improvement of anesthesia equipment, visual technology, and anesthesia skills, we began to experiment with muscle relaxants.…”

Section: Discussionmentioning

confidence: 99%

A retrospective observational study of anesthesia management during the flexible or rigid bronchoscopy in patients with central airway obstruction: Safety application of muscle relaxants and the traditional Low-frequency ventilation

Li¹,

Li²,

Ma³

et al. 2020

Preprint

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Background: Bronchoscopy treatments of central airway obstruction (CAO) under general anesthesia are high-risky procedures, and posing a giant challenge to the anesthesiologists. We summarized and analyzed our clinical experience in anesthesia management in patients with CAO undergoing flexible or rigid bronchoscopy, including the use of muscle relaxants , the traditional Low-frequency ventilation.Methods: Clinical data of 375 patients with CAO who underwent urgent endoscopic treatments in general anesthesia from January 2016 to October 2019 were retrospectively reviewed. The use ratio of skeletal muscle relaxants, dose of skeletal muscle relaxants used, the incidence of perioperative adverse events, adequacy of ventilation and gas exchange, post-operative recovery between rigid bronchoscopy and flexible bronchoscopy therapy, and risk factors for postoperative ICU admission were evaluated.Results: There was a high usage rate (96.5%) of skeletal muscle relaxants in patients with CAO who underwent either flexible bronchoscopy or rigid bronchoscopy therapy and a higher dosage of skeletal muscle relaxants used in rigid bronchoscopy compared with flexible bronchoscopy therapy. This procedure had a low incidence of perioperative adverse events, with no significant difference between flexible and rigid bronchoscopy therapy. Sufficient ventilation was successfully established using the traditional Low-frequency ventilation both in flexible and rigid bronchoscopy group. There was a low mortality (0.8%) during the post-operative recovery, and the higher grade of American Society of Anesthesiologists (ASA) and obvious dyspnea or orthopnea were the independent risk factors for postoperative ICU admission.Conclusion: The muscle relaxants and low-frequency traditional ventilation can be safely used both in flexible and rigid bronchoscopy treatments in patients with CAO These results may provide strong clinical evidence for optimizing the anesthesia management of bronchoscopy for such patients.

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Anesthetic considerations for bronchoscopic procedures: a narrative review based on the Cleveland Clinic experience

Cited by 28 publications

References 86 publications

High frequency jet ventilation through mask contribute to oxygen therapy in patients undergoing bronchoscopic intervention under deep sedation

High frequency jet ventilation through mask contribute to oxygen therapy in patients undergoing bronchoscopic intervention under deep sedation

Anesthesia Management in Patients With Central Airway Stenosis Undergoing Bronchoscopy Treatments - Safety Application of Muscle Relaxants and the Traditional Low-frequency Ventilation : A Retrospective Observational Study

A retrospective observational study of anesthesia management during the flexible or rigid bronchoscopy in patients with central airway obstruction: Safety application of muscle relaxants and the traditional Low-frequency ventilation

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