Evaluation of Safety and Short-term Outcomes of Therapeutic Rigid Bronchoscopy Using Total Intravenous Anesthesia and Spontaneous Assisted Ventilation

Abstract

<b><i>Background:</i></b> There is a paucity of published data regarding the optimal type of anesthesia and ventilation strategies during rigid bronchoscopy. <b><i>Objective:</i></b> The aim of our study is to report the procedural and anesthesia-related complications with rigid bronchoscopy using total intravenous anesthesia and spontaneous assisted ventilation. <b><i>Methods:</i></b> A retrospective review of patients undergoing therapeutic rigid bronchoscopy at the University of Chicago between October 2012 and December 2014 was performed. Data were recorded relating to patients’ demographics, comorbidities, type of anesthesia, need for neuromuscular blockade (NMB), intraoperative hypoxemia, hypotension, perioperative adverse events, and mortality. <b><i>Results:</i></b> Fifty-five patients underwent 79 rigid bronchoscopy procedures; 90% were performed for malignant disease and 90% of patients had an American Society of Anesthesiologists (ASA) class III or IV. The majority (76%) did not require use of NMB. The most common adverse events were intraoperative hypoxemia (67%) and hypotension (77%). Major bleeding and postoperative respiratory failure occurred in 3.8 and 5.1% of procedures, respectively. There was no intraoperative mortality or cardiac dysrhythmias. The 30-day mortality was 7.6% and was associated with older age, inpatient status, congestive heart failure, home oxygen use, and procedural duration. Intraoperative hypoxemia, hypotension, and ASA class were not associated with 30-day mortality. The majority (94%) of patients were discharged home. The use of NMB did not impact outcomes. <b><i>Conclusions:</i></b> This study suggests that therapeutic rigid bronchoscopy can be safely performed with total intravenous anesthesia and spontaneous assisted ventilation in patients with central airway obstruction, significant comorbidities, and a high ASA class. The only significant modifiable variable predicting the 30-day mortality was the duration of the procedure.

Complications of rigid bronchoscopy

“…demonstrated that re‐intervention and mortality rates are higher for RB procedures that are performed emergently 18 . This study, however, did not report on the association of ASA score with mortality which has been demonstrated in prior publications 14,17 …”

Rigid bronchoscopy in malignant airway fistula using dexmedetomidine

“…Eventually, intraoperative fatal outcomes are not uncommon (8). A very recent study by Murgu et al suggests that RB can be safely performed with total intravenous anesthesia and spontaneous ventilation (9). However, in their study dexmedetomidine was only used in two patients without evidence of the procedure details.…”

Feasibility and safety of a novel electrosurgery device as part of multi-modal bronchoscopic therapy for malignant central airway lesions

“…We believe that a future study should evaluate the adjuvant role of CoreCath 2.7S in regards to safety profile, recanalization rate, time to repeat intervention and duration of procedure, ideally in a prospective comparative trial. A recent study suggests that the only modifiable risk factor associated with mortality among patients undergoing rigid bronchoscopy is the duration of anesthesia (24). This is usually due to the need of continuously adjusting the FiO 2 for thermal energy application while trying to avoid severe hypoxemia.…”