SAFETY OF GENERAL ANESTHESIA DURING INTERVENTIONAL BRONCHOSCOPY PROCEDURE

Abstract

SESSION TITLE: Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Technologic advancements in Interventional Pulmonary have increased the technical complexity and consequently duration of many bronchoscopic procedures, increasing the need for both deeper and longer sedation. In fact, at our institution, the vast majority of bronchoscopies are performed under general anesthesia. While bronchoscopy is generally considered a safe procedure with relatively few intra-procedural complications, the safety of general anesthesia during bronchoscopy has not yet been fully described. METHODS: This study is a retrospective chart review analyzing data from 295 patients who underwent bronchoscopy between August 2017 -October 2018. These procedures are performed in our Endoscopy Unit, where standard cardiopulmonary monitoring and anesthesia equipment is available. ASA Physical Status Classification is assigned by the Anesthesia team pre-procedurally. If the procedure was terminated as a consequence of an intra-procedural event, it was considered a complication. Patients who were free of complications for two hours post-procedure were considered to have not had a procedural complication.Transient intra-procedural hypotension resolving by the end of the procedure is considered an expected side effect of anesthesia and not reported as a complication; RESULTS: Of the 295 bronchoscopies, 98.3% (290) were performed under general anesthesia. The patient cohort was 44% female; 60% White, 38% African-American and 1% Hispanic . The median age was 63 years-old and average BMI is 26.8 . Patients had multiple medical comorbidities with 19% ASA-2, 68% ASA-3, and 13% ASA-4. Respiratory complications: Acute respiratory failure occurred in eight patients of whom four required ICU admissions on mechanical ventilation, two patients admitted to medicine floor, and two discharged on the same day after oxygen and nebulizer treatments. Cardiovascular complications: No patients experienced acute coronary syndrome, but two patients had heart failure exacerbation, who were appropriately treated and released. Only one patient had a hypotensive episode requiring early termination of the procedure. CONCLUSIONS: In our experience, general anesthesia for bronchoscopy was only rarely associated with significant complication, despite ASA scores that are typically associated with significant risk, and taking into consideration the patient's underlying respiratory pathologies. Overall, bronchoscopy is a safe procedure to be done under general anesthesia even in patients with multiple comorbidities. CLINICAL IMPLICATIONS: As technological advancements in the field of Interventional Pulmonology are occurring at a rapid rate, the need for general anesthesia to facilitate longer and more complex procedures may be increasing. We have provided data to support that even in patient's with serious comorbid conditions, general anesthesia for bronchoscopy is a safe procedure. DISCLOSURES: No relevant relationships by Ammar Alqaid, source=Web Response No relevant relationships by Rishi Arora, source=Web Response No relevant relationships by David Chambers, source=Web Response No relevant relationships by Allen Elster, source=Web Response No relevant relationships by Paul Fisher, source=Web Response No relevant relationships by UZAIR GHORI, source=Web Response Site investigator for EMPROVE relationship with olympus Please note: $1001 - $5000 Added 06/15/2020 by Robert Holladay, source=Web Response, value=Grant/Research Support No relevant relationships by Aditya Sithamraju, source=Web Response