Gülay ÜLGER, Hilal SAZAK, Melahat UZEL ŞENER, Ayperi ÖZTÜRK, Musa ZENGİN, Ali ALAGÖZ

Anesthesia management and challenges during interventional pulmonology procedures for central airway obstructions

Aim: Central airway obstructions (CAO) are one of the main reasons for morbidity and mortality, often originate in the lungs, and are generally unresectable. Interventional airway procedure is a preferred method in these cases. This study aimed to analyze anesthesia management in patients undergoing interventional procedures for CAO. We aimed to highlight the problem and solutions that may be encountered in such cases. Material and Method: The data of 49 patients who had interventional airway procedure were analyzed retrospectively. Patients’ demographic data, type of interventional procedures, localization of the lesion, and duration of the procedure were analyzed. Vital parameters and arterial blood gases (ABG) levels had been recorded before anesthesia induction (T1), after rigid bronchoscope insertion (T2), 20th-minute of the procedure (T3), after extubation (T4), and in the postoperative care unit (T5). Results: The mean age was 57.90±11.99 years. The mean duration of the procedure was 34.75±15.62 minutes. The majority of the patients had American Society of Anesthesiologists (ASA) III-IV physical status. CAOs were mostly found in the main bronchus. Tumors debulking, biopsy, mechanical dilatation, argon plasma coagulation, and mechanical tumor resection were the most performed procedures. Stent insertion was performed in 3 (6.1%) patients. Two patients (4.1%) had bleeding, 3 (6.1%) patients had desaturation, and 1 (2.1%) patient had atrial fibrillation. Conclusion: Interventional airway procedures are frequently used for high risk patients with CAO and comorbidities. Detailed preoperative evaluation, periprocedural teamwork, and close hemodynamic and ABG follow-up are keys to success.

Keywords:

Anesthesia, argon plasma coagulation, central airway obstruction, cryotherapy, interventional pulmonology, rigid bronchoscopy,

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Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004; 169: 1278-97.
Ayers ML, Beamis JF Jr. Rigid bronchoscopy in the twenty-first century. Clin Chest Med 2001; 22: 355-64.
Noppen M, Meysman M, D’Haese J, Schlesser M, Vincken W. Interventional bronchoscopy: 5-year experience at the Academic Hospital of the Vrije Universiteit Brussel (AZ-VUB). Acta Clin Belg 1997; 52: 371-80.
Beyazit Y , Tanoglu A , Kekilli M , Kurt M. Successful Management of an Esophageal Foreign Body with a Rigid Bronchoscopy. Medicine Science. 2015; 4: 2340-43.
El-Dawlatly A, Alnassar S, Abodonya A, Almutlaq N, Hajjar W. Anesthetic considerations of central airway obstruction. Saudi J Anaesth 2011; 5: 326-8.
José RJ, Shaefi S, Navani N. Anesthesia for bronchoscopy. Curr Opin Anaesthesiol 2014; 27: 453-7.
de Lima A, Kheir F, Majid A, Pawlowski J. Anesthesia for interventional pulmonology procedures: a review of advanced diagnostic and therapeutic bronchoscopy. Can J Anaesth 2018; 65: 822-36.
McMahon CC, Rainey L, Fulton B, Conacher ID. Central airway compression. Anaesthetic and intensive care consequences. Anaesthesia 1997; 52: 158-62.
Abdullayev R, Akçaboy EY, Akçaboy ZN, Tiryaki HC, Bavullu EN, Göğüş N. Fentanile bağlı olarak görülen öksürüğe deksmedetomidinin etkisi. Turk J Anaesth Reanim 2013; 41, 80-3.
Goudra BG, Singh PM, Borle A, Farid N, Harris K. Anesthesia for advanced bronchoscopic procedures: state-of-the-art review. Lung 2015; 193: 453-65.
Bavullu EN, Aksoy E, Abdullayev R, Göğüş N, Dede D. Comparison of dexmedetomidine and midazolam in sedation for percutaneous drainage of hepatic hydatid cysts. Turk J Anaesthesiol Reanim 2013; 41: 195-9.
Zengin M, Baldemir R. Anesthesia management in geriatric patients which were interventional bronchoscopy due to central airway obstruction; retrospective analysis. Anatolian Curr Med J 2022; 4; 39-43.
Zengin M, Alagoz A. Comparison of thoracic epidural analgesia and thoracic paravertebral block applications in the treatment of acute pain after thoracotomy in geriatric patients. Cureus 2021; 13; 10, e18982.
Bolliger CT, Mathur PN, Beamis JF, et al; European Respiratory Society/American Thoracic Society. ERS/ATS statement on interventional pulmonology. European Respiratory Society/American Thoracic Society. Eur Respir J 2002; 19: 356-73.
Schleicher A, Groeben H. Anesthetic considerations for tracheobronchial surgery. Journal of Thoracic Disease 2020; 12: 6138-42.
Semmelmann A, Loop T. Anesthesia for interventional pulmonology. Curr Opin Anaesthesiol 2022; 35: 82-8.
Abdelmalak BB, Doyle DJ. Updates and controversies in anesthesia for advanced interventional pulmonology procedures. Curr Opin Anaesthesiol 2021; 34: 455-63.
Selzer AR, Murrell M, Shostak E. New trends in interventional pulmonology. Curr Opin Anaesthesiol 2017; 30: 17-22.
Bakan M, Topuz U, Umutoglu T, et al. Remifentanil-based total intravenous anesthesia for pediatric rigid bronchoscopy: comparison of adjuvant propofol and ketamine. Clinics (Sao Paulo) 2014; 69: 372-7.
Conacher ID, Curran E. Local anaesthesia and sedation for rigid bronchoscopy for emergency relief of central airway obstruction. Anaesthesia 2004; 59: 290-2.
Pathak V, Welsby I, Mahmood K, Wahidi M, MacIntyre N, Shofer S. Ventilation and anesthetic approaches for rigid bronchoscopy. Ann Am Thorac Soc 2014; 11: 628-34.
Sparr HJ, Jöhr M. Succinylcholin-Update [Succinylcholine--update]. Anaesthesist 2002; 51: 565-75.
Pawlowski J. Anesthetic considerations for interventional pulmonary procedures. Curr Opin Anaesthesiol 2013; 26: 6-12..
Han TH, Martyn JA. Onset and effectiveness of rocuronium for rapid onset of paralysis in patients with major burns: priming or large bolus. Br J Anaesth 2009; 102: 55-60.
Lee C, Jahr JS, Candiotti KA, Warriner B, Zornow MH, Naguib M. Reversal of profound neuromuscular block by sugammadex administered three minutes after rocuronium: a comparison with spontaneous recovery from succinylcholine. Anesthesiology 2009; 110: 1020-5.
Putz L, Mayné A, Dincq AS. Jet Ventilation during rigid bronchoscopy in adults: a focused review. Biomed Res Int 2016; 4234861.
Evans E, Biro P, Bedforth N. Jet ventilation. Contin Educ Anaesthesia Critical Care &Pain 2007; 7: 2-5.
Dincq AS, Gourdin M, Collard E, et al. Anesthesia for adult rigid bronchoscopy. Acta Anaesthesiol Belg 2014; 65: 95-103.
Fernandez-Bustamante A, Ibañez V, Alfaro JJ, et al. High-frequency jet ventilation in interventional bronchoscopy: factors with predictive value on high-frequency jet ventilation complications. J Clin Anesth 2006; 18: 349-56.
Platt RC. Argon plasma electrosurgical coagulation. Biomed Sci Instrum 1997; 34: 332-7.
Grund KE, Storek D, Farin G. Endoscopic argon plasma coagulation (APC) first clinical experiences in flexible endoscopy. Endosc Surg Allied Technol 1994; 2:42-6.
Mudambi L, Miller R, Eapen GA. Malignant central airway obstruction. J Thorac Dis. 2017; 9: 1087-110.
Morice RC, Ece T, Ece F, Keus L. Endobronchial argon plasma coagulation for treatment of hemoptysis and neoplastic airway obstruction. Chest 2001; 119: 781-7.