Abstract
Aim: In the endobronchial treatment of tumors that cause obstruction in the tracheobronchial system; Applications such as cryo-recanalization and argon plasma coagulation (APC) are widely used. Patients presenting with central airway obstruction (CAO) require urgent intervention, sharing the airway with the bronchoscopist, severe shortness of breath in patients, and the presence of comorbid diseases make it difficult for anesthetists. This situation becomes more complicated due to pharmacokinetic and pharmacodynamic changes in geriatric patients. In this article, it is aimed to present the anesthesia method in geriatric patients who underwent interventional bronchoscopy due to central airway obstruction.
 Material and Method: The files of geriatric patients who underwent interventional procedures for central airway obstruction between January 2021 and September 2021 were reviewed retrospectively. The treatments applied to the patients and the applied anesthetic protocols were recorded.
 Results: Forty-five geriatric patients who underwent interventional procedures for CAO were identified. 74% of the patients were male. 95.6% of the patients were in the American Society of Anesthesiologists (ASA) III or ASA IV risk group, which we can refer to as the high risk group. It was observed that rapid and short-acting propofol and remifentanil were used in induction and maintenance of anesthesia, rocuronium was used as muscle relaxant, and sugammadex was used to eliminate the residual effect of the muscle relaxant.
 Conclusion: Airway management is very complex in severe life-threatening airway stenosis. This situation requires a more comprehensive preoperative evaluation, selection of appropriate short-acting anesthetics, and effective anesthetic monitoring, especially in geriatric patients. In addition, the anesthetist and bronchoscopist should be prepared and in constant communication against complications that may develop.
Highlights
Rigid bronchoscopy, cryorecanalization and argon plasma coagulation (APC) applications are increasingly used to remove or reduce tumors that cause obstruction in the endobronchial system [1]
It was observed that rapid and short-acting propofol and remifentanil were used in induction and maintenance of anesthesia, rocuronium was used as muscle relaxant, and sugammadex was used to eliminate the residual effect of the muscle relaxant
Between January 2021 and September 2021, a total of 111 patients underwent interventional procedures for central airway obstruction (CAO). 47 of them were in the geriatric age group. 2 patients were excluded from the study due to missing data (Figure)
Summary
Cryorecanalization and argon plasma coagulation (APC) applications are increasingly used to remove or reduce tumors that cause obstruction in the endobronchial system [1]. General anesthesia is usually required during rigid bronchoscopy [3]. Patients with central airway obstruction (CAO) require urgent intervention, sharing the airway with the bronchoscopist, severe shortness of breath in patients and the presence of comorbid diseases complicate the work of anesthesiologists. It is possible to achieve the desired effect with fewer drugs in geriatric patients, and the drug effect is generally prolonged in the elderly population [4]. This difference in geriatric patients is mainly due to the difference in kidney and liver metabolism and, changes in pharmacokinetic and pharmacodynamic responses [5,6,7]. It was aimed to present our anesthesia management experience in the treatment of severe airway stenosis in geriatric patients
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