PUB028 The Use of an EBUS TBNA Friendly Larynx Mask

Abstract

Optimal performance of endobronchial ultrasound guided trans-bronchial needle aspiration (EBUS-TBNA) requires both anesthesia care and procedural sedation with the aim of providing patient with as much comfort as possible while also ensuring the operating physician has optimal working conditions. By managing the airway with a supraglottic airway, the upper para-tracheal nodes will be accessible. Deep anesthesia can be avoided, due to effective usage of local topical anesthesia will ensure stable operating conditions without coughing or other discomfort for the patient. The Ambu AuraGain is a second-generation supraglottic airway with a short wide airway tube, combined with a flat back plate creates stability after placement and a better access of the EBUS-TBNA scope. The oral part of the tube prevents the possibility of harming the scope if the patient bites the teeth together The objective of this study was to assess the clinical performance of the AuraGain used as a conduit for EBUS-TBNA. The study included 20 cases, ASA II-III, eligible for a size 3, 4 or 5 supraglottic airway. The assessment included insertion, working as a conduit for bronchoscopy, fiberoptic assessment of anatomic fit and complications. After each procedure the performance were evaluated by the anesthetist and the endoscopist. First attempt insertion success rate was 95% with an overall success rate of a 100%. Average intra cuff pressure to obtain seal was 55.55 cmH2O, and ventilation was performed without leak at up to pPeak of 35 cmH2O which was the maximum pressure permitted. Assessment of ease of maneuvering an EBUS scope via the AuraGain was evaluated. Especially the resistance to advance, retract and rotate the scope in the trachea and the bronchial tree was evaluated based on a 3-point scale, defined as: little resistance, moderate resistance or high resistance. 90% recorded passing a scope as being with little resistance, moderate resistance was felt in 2 cases, and no records of high resistance was experienced. One episodes of patient coughing and biting was recorded, which was due to inadequate anesthesia, but because of the integrated bite absorption area, no dental damage or damage to the scope occurred. Fiberoptically assessment of alignment of AuraGain and the trachea was recorded as 100% satisfactory to accommodate performance of the EBUS procedure with needle aspiration of lymphoid nodes of down 3.mm. The AuraGain was effectively utilized for airway management and with a high degree of success for as a conduit for EBUS-TBNA.