Supraglottic airway versus endotracheal tube during interventional pulmonary procedures \u2013 a retrospective study

Kyle M Behrens,Richard E Galgon

doi:10.1186/s12871-019-0872-x

Abstract

BackgroundAs the field of interventional pulmonology (IP) expands, anesthesia services are increasingly being utilized when complex procedures of longer duration are performed on sicker patients with high risk co-morbidities and lung pathology. Yet, evidence on the optimal anesthetic management for these patients remains lacking. Our aim was to characterize the airway management and, secondarily anesthetic maintenance patterns used for IP procedures at our institution.MethodsFrom 2894 identified encounters, charts of 783 patients undergoing an IP procedure with general anesthesia over a 5-year period, employing an endotracheal tube (ETT) or a supraglottic airway (SGA) for airway maintenance, were identified and reviewed after exclusions. Patients posted for a concurrent thoracic surgical procedure and those already intubated at presentation were excluded. Baseline patient demographics, procedure, proceduralist type, anesthesia maintenance modality, neuromuscular blocking drug (NMBD) use, and airway management characteristics were extracted and analyzed.ResultsInhaled general anesthesia with an ETT for airway maintenance was most commonly employed; however, SGAs were used in one-third of patients with a very low conversion rate (0.4%), and their use was associated with a significant reduction in NMBD use.ConclusionsIn this large series of patients receiving general anesthesia for IP procedures, inhaled anesthetic agents and ETTs were favored. However, in appropriately selected patients, SGA use was effective for airway maintenance and allowed for a reduction in NMBD use, which may have implications in this patient population who may have an increased risk for pulmonary complications and warrants further investigation.

Highlights

As the field of interventional pulmonology (IP) expands, anesthesia services are increasingly being utilized when complex procedures of longer duration are performed on sicker patients with high risk co-morbidities and lung pathology
Many US and European medical centers have made it standard practice to have an anesthesiologist provide either sedation or general anesthesia to selected high risk patients undergoing IP procedures to safely manage them [3, 4]. It has been nearly 35 years since supraglottic airways (SGAs) have been released for anesthetic practice; SGAs have not been the standard of care to facilitate IP procedures due to the increased potential for dislodgement and less airway control compared to endotracheal tube (ETT)
The main finding of this study is that usage of SGAs for IP procedures can be highly successful with a low conversion rate to ETT when used in appropriately selected patients

Summary

Introduction

As the field of interventional pulmonology (IP) expands, anesthesia services are increasingly being utilized when complex procedures of longer duration are performed on sicker patients with high risk co-morbidities and lung pathology. Sicker patients with high risk co-morbidities and lung pathology are able to undergo less invasive procedures resulting in shorter hospital stays. It is common for patients with less co-morbidities to be managed effectively using conscious sedation during these. It has been nearly 35 years since supraglottic airways (SGAs) have been released for anesthetic practice; SGAs have not been the standard of care to facilitate IP procedures due to the increased potential for dislodgement and less airway control compared to endotracheal tube (ETT). Data on the use of SGAs for other procedures remains lacking

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