Airway Control Research Articles

Vertebra critica in a case of near-hanging

Objective: To demonstrate the significance of fused cervical vertebrae in emergency medicine practice. Case Presentation: A 35-year-old male was brought to the emergency department (ED) who attempted suicide by hanging and was later found to have congenital fusion of cervical vertebra C2 and C3, a condition referred to as - vertebra critica. This is the only case report of a patient with vertebra critica admitted for near hanging. The patient was intubated with a Portex® North Polar endotracheal tube (ETT) through the nasal route. This proved to be a critical decision as it helped early airway control avoiding any complication. Conclusion: As the victims of near-hanging should have cervical spine restriction, judicious use of flexible portex® ETT may help in early intubation and resuscitation without aggravating the neurological injuries. It must be noted that nasal intubation is contraindicated in base of skull fractures and it should be avoided in patients with obvious traumatic injury to the neck including laryngeal trauma, tracheal disruption and vessel injuries.

Personalized target therapy for severe bronchial asthma in combination with polypous rhinosinusitis

Bronchial asthma is a current problem of health care in connection with high prevalence and heterogeneity of a disease. Development and deployment in clinical practice of genetically engineered biological medicines for treatment of patients with severe eosinophilic bronchial asthma allowed to change cardinally the course of a disease and to considerably improve quality of life of such patients. The presented clinical case focuses on the experience of using benralizumab, an interleukin-5 receptor antagonist in a patient with T2-endotype of severe bronchial asthma in combination with polypous rhinosinusitis. The diagnosis of bronchial asthma was established to the patient in 36 years. The patient had the burdened allergological personal and family anamnesis, intolerance of nonsteroid anti-inflammatory medicines, polyps in a nose were revealed later. It is known that the clinical phenotype of a combination of bronchial asthma to a polypous rhinosinusitis is difficult for treatment in connection with the inflammation which was more expressed, difficult giving in to control in airways. Over time the course of a disease was made heavier, control of symptoms was lost and, despite the therapy volume corresponding to the 5th step on GINA, including reception of system glucocorticosteroids, an exception of all factors interfering achievement of control regular symptoms and frequent aggravations remained. In accordance with the Federal Guidelines, the patient was prescribed targeted therapy with benralizumab, which suppresses eosinophilic inflammation in the respiratory tract. During the treatment, a rapid significant improvement in the patient’s condition was noted in the form of a decrease in asthma symptoms, normalization of spirography indicators, and cessation of exacerbations. The persistent clinical effect allowed to abandon the use of systemic glucocorticosteroids without losing control of the disease. There were no adverse reactions to the drug administration. Thus, therapy with benralizumab in patients with the T2-endotype of severe bronchial asthma in combination with polypous rhinosinusitis is safe and highly effective and allows it to be recommended for widespread use in clinical practice.

Total Hip Replacement in a Case of Ankylosing Spondylitis: Anesthetist’s Preparedness

Ankylosing Spondylitis is an autoimmune seronegative spondyloarthropathy which manifests as a relapsing remitting disease. Since the disease involves the spine, it becomes significant for anesthesiologists as ensuring airway control in general anesthesia, and regional neuraxial blockade becomes difficult. Hence the anesthesiologist should be prepared beforehand with the anesthesia plan and the backup plan if the primary plan fails. In this report, we highlight the anesthetic management of a 66 year-old male who was a known case of ankylosing spondylitis and was planned for a total hip replacement.

TRANSVENOUS PHRENIC NERVE STIMULATION EFFECTIVELY TREATS CENTRAL SLEEP APNEA DURING BOTH RAPID AND NONRAPID EYE MOVEMENT SLEEP

TRANSVENOUS PHRENIC NERVE STIMULATION EFFECTIVELY TREATS CENTRAL SLEEP APNEA DURING BOTH RAPID AND NONRAPID EYE MOVEMENT SLEEP

Effect of Continuous Positive Airway Pressure in Phase-I Cardiac Rehabilitation after CABG

Background: Coronary artery bypass surgery is associated with sever alteration of Lung parameters after 1st post-operative day. The purpose of this study to determine The effect of CPAP on, arterial blood gasses, walking time and long term effect on Ejection fraction and quality of life. Objective: To determine the effect of continues positive airway pressure on arterial blood gases, walking time, long term effect on ejection fraction and quality of life in post coronary artery bypass grafting patients. Methods: Randomized control study was conducted in North West General Hospital Peshawar, from July 2019 to December 2019. Patients underwent coronary artery bypass grafting were included in cardiac rehabilitation. 60 patients were randomly divided into two groups with equal half’s. Experimental group received exercises with continues positive airway pressure (CPAP) and control group received only exercise. PAP was applied 20 minutes prior to exercise and ABG’s test and Vitals were recorded after 5minutes of exercise. Walking time was observed by 6MWT on last day of hospital discharge. Ejection fraction was observed by Echo and quality of life by SF12 questionnaire after four weeks. Results: mean age in control group was (55.27±8.80) and in experimental group was (4.70±1.535). Mean and standard deviation of post Echo in experimental group was 48.30±1.493 and control group was 46.17±1.191. Both groups showed significant difference P value less than 0.05 in arterial blood gases PH, HCO3, and PCO2. PO2 showed significant difference only in experimental group. Both groups showed statistically significant difference for 6 MWT. Mean of quality of life in experimental group was 37.4±5.062 and in control was 36.54±4.46. Conclusion: it is concluded that the use of CPAP in post CABG patients have effective outcome in arterial blood gases, walking time, ejection fraction and in quality of life. Keywords: Continuous Positive Airway Pressure, Coronary artery bypass graft surgery, Inpatients rehabilitations.

Computational assessment of upper airway muscular activity in obstructive sleep apnea – In vitro validation

Neuromuscular control of the upper airway contributes to obstructive sleep apnea (OSA). An accurate, non-invasive method to assess neuromuscular function is needed to improve surgical treatment outcomes. Currently, surgical approaches for OSA are based on airway anatomy and are often not curative. When the airway surface moves, the power transferred between air in the airway lumen and the structures of the upper airway may be a measure of airway neuromuscular activity. The aim of this study was to validate power transfer as a measure of externally applied forces, representing neuromuscular activity, through cine computed tomography (CT) imaging and computational fluid dynamics (CFD) analysis in a 3D-printed airway model. A hollow elastic airway model was manufactured. An insufflation/exsufflation device generated airflow within the model lumen. The model was contained in an airtight chamber that could be positively or negatively pressurized to represent muscular forces. These forces were systematically applied to dilate and collapse the model. Cine CT imaging captured airway wall movement during respiratory cycles with and without externally applied forces. Power transfer was calculated from the product of wall movement and internal aerodynamic pressure forces using CFD simulations. Cross-correlation peaks between power transfer and changes in externally applied pressure during exhalation and inhalation were −0.79 and 0.95, respectively. Power transfer calculated via cine CT imaging and CFD was an accurate surrogate measure of externally applied forces representing airway muscular activity. In the future, power transfer may be used in clinical practice to phenotype patients with OSA and select personalized therapies.

Airway Pressure Release Ventilation for Acute Respiratory Distress Syndrome: An Update


 Evidence suggested there was no significant difference in mortality between patients with or at risk of acute respiratory distress syndrome treated with airway pressure release ventilation versus other mechanical ventilation strategies.
 The evidence of the clinical effectiveness of airway pressure release ventilation in patients with or at risk of acute respiratory distress syndrome is uncertain for several outcomes (length of intensive care unit stay, oxygenation, ventilator-free days, mean arterial pressure). Evidence from some studies suggested there was a significant benefit favouring airway pressure release ventilation versus other mechanical ventilation strategies for these outcomes, other studies suggested there was a significant benefit favouring other mechanical ventilation strategies, and some studies found no significant differences between treatment groups.
 Results from 1 study suggested there were no significant differences in incidence of acute respiratory distress syndrome between patients treated with airway pressure release ventilation versus pressure-controlled synchronized intermittent mandatory ventilation and pressure support.
 Evidence suggested there was no significant difference in tracheostomy between patients with or at risk of acute respiratory distress syndrome treated with airway pressure release ventilation versus control. In 1 study significantly more patients treated with airway pressure release ventilation experienced severe hypercapnia than those treated with low tidal volume ventilation.
 One guideline suggests considering the use of airway pressure release ventilation in patients without severe acute respiratory distress syndrome.

Expert Multinational Consensus Statement for Total Intravenous Anaesthesia (TIVA) Using the Delphi Method.

Introduction: The use of total intravenous anaesthesia (TIVA) has been well established as an anaesthetic technique over the last few decades. Significant variation in practice exists however, and volatile agents are still commonly used. This study aims to determine the motivations and barriers for using TIVA over the use of volatile agents by analysing the opinion of several international anaesthetists with specific expertise or interests. Methods and participants: The Delphi method was used to gain the opinions of expert panellists with a range of anaesthetic subspecialty expertise. Twenty-nine panellists were invited to complete three survey rounds containing statements regarding the use of TIVA. Anonymised data were captured through the software REDCap and analysed for consensus and prioritisation across statements. Starting with 12 statements, strong consensus was defined as ≥75% agreement. Stability was assessed between rounds. Results: Strong consensus was achieved for four statements regarding considerations for the use of TIVA. These statements addressed whether TIVA is useful in paediatric anaesthesia, the importance of TIVA in reducing the incidence of postoperative nausea and vomiting, its positive impact on the environment and effect on patient physiology, such as airway and haemodynamic control. Conclusions: Using the Delphi method, this international consensus showed that cost, lack of familiarity or training and the risk of delayed emergence are not considered obstacles to TIVA use. It appears, instead, that the primary motivations for its adoption are the impact of TIVA on patient experience, especially in paediatrics, and the benefit to the overall procedure outcome. The effect of TIVA on postoperative nausea and vomiting and patient physiology, as well as improving its availability in paediatrics were considered as priorities. We also identified areas where the debate remains open, generating new research questions on geographical variation and the potential impact of local availability of monitoring equipment.

Ludwig’s angina an analysis of cases seen at tertiary care hospital

<p>We diagnosed and treated four cases of Ludwig's angina who had edema of the floor of the mouth and the tongue along with submandibular swelling and inability to open the mouth. All the patients have dental infection. Incision aid drainage given to all of the patients through the sub mental region immediately after admission under local anaesthesie. The edema and trismus subsided gradually. All the patients required daily dressing. Despite the dressing incidence of the disease, Ludwig's angina remains an important cause of airway obstruction that can have disastrous consequences. Proper diagnosis, airway control, antibiotic therapy and surgical incision and drainage are essential to ensure the safety of the patients.</p>

0708 Stage-dependent Differences in Central Sleep Apnea (CSA) Predominate in remedē System Pivotal Trial Participants

Abstract Introduction Differences in neuroventilatory control can impact the type and severity of sleep disordered breathing between non-REM and REM sleep. We examined the distribution of central apneic episodes in polysomnograms from subjects with predominantly central sleep apnea, who received phrenic nerve stimulation. Methods Baseline in-lab polysomnograms from patients enrolled in the remedē System Pivotal Trial were scored by a central core laboratory (n=151). Participants with predominantly CSA were enrolled if the apnea-hypopnea index (AHI)≥20/hr, the central apnea index (CAI) exceeded the obstructive apnea index (OAI), and the OAI did not exceed 20% of the total AHI. This post-hoc analysis compared sleep apnea indices in REM and non-REM sleep in those with ≥5 minutes REM sleep (n=131). Within-patient median non-REM - REM differences were calculated and compared. Results REM sleep time was 40 [Q1=28, Q3=64] minutes, and non-REM sleep time was 301 [Q1=269,Q3=344] minutes. AHI in REM sleep was 22/hr [Q1=9,Q3=44] and was 46/hr (Q1=33,Q3=60) in non-REM sleep, yielding a within-patient difference between non-REM and REM sleep of 22/hr ([Q1=6, Q3=34], p<.001). CAI in REM was only 4/hr (Q1=0, Q3=11), but in non-REM was 25/hr [Q1=16,Q3=43] with all patients having a CAI≥5/hr during non-REM. In REM, 70% had a CAI>0/hr and 46% had a CAI ≥5/hr. The CAI difference between non-REM and REM sleep was 18/hr [Q1=10, Q3=30; p<.001]. The OAI and mixed apnea index (MAI) differed by <1/hr (p=0.235 and <.001, respectively). Of note, the hypopnea index [HI] did not differ between REM and non-REM sleep (12/hr [Q1=2,Q3=22] vs. 11/hr [Q1=4, Q3=20], respectively, p=0.273), yet hypopneas constituted a greater proportion of total AHI during REM compared to non-REM sleep. Conclusion Among subjects with predominantly CSA, the prevalence and severity of CSA was greater in non-REM than REM sleep, yet low-level CSA persisted in REM sleep. Stage-related differences in CAI but not OAI, MAI or HI can be attributed to alterations in ventilatory rather than upper airway control in this CSA cohort. These differences in the type and severity of sleep disordered breathing episodes comprise a key diagnostic signature, for which specific CSA therapeutic strategies are indicated. Support (If Any) ZOLL Respicardia, Inc. and NIH R01 HL144859

Significant brainstem dysfunction in neonates with myelomeningoceles: a comparison of prenatal versus postnatal closure.

The purpose of this study was to compare the incidence of significant brainstem dysfunction (SBD) in neonates with myelomeningocele who have been treated with prenatal versus postnatal closure at a single institution. The records and imaging of all children undergoing either prenatal (n = 27) or postnatal (n = 60) closure of myelomeningocele at the authors' institution from December 2014 through May 2021 were reviewed. SBD, fetal ventricular size, gestational age at fetal imaging and delivery, postnatal ventricular size, need for and type of hydrocephalus treatment, spinal neurological level at birth, anatomical Chiari severity, death, and prenatal or postnatal repair were factors recorded. SBD was defined by need for airway surgery or gastrostomy tube, or endotracheal intubation because of apnea, aspiration, or airway control problems. Comparisons between prenatal and postnatal cohorts and between the cohorts with and without SBD were performed. SBD occurred in 25% and 0% of neonates who underwent postnatal and prenatal closure, respectively. There were no differences in fetal ventricular size or spinal neurological level between the prenatal and postnatal cohorts or between those with or without SBD. Anatomical severity of the Chiari malformation after birth was worse in the postnatal cohort. Hydrocephalus treatment was required in 70% and 33% of infants who underwent postnatal and prenatal closure, respectively. All three deaths were in the postnatal group from SBD. Prenatal closure of myelomeningocele is associated with a significant reduction in SBD.

Post-General Anesthesia Angioedema After General Anesthesia

<strong>Background</strong>: General anesthesia includes the administration of avariety medicines to patient/in/ fairly short/period. Numerous negative consequences can occur because of reaction from the drugs given, one example is anaphylaxis that may lead to death if not been recognized and handled quickly & promptly.<p><strong>Case Illustration:</strong><strong> </strong>A sixty-seven years old male patient 152 cm 65 kg with multiple cholecystitis and obstructive jaundice, who was scheduled to undergo laparoscopic cholecystectomy. Patient had no records of allergy to medication and food. Family has no records to hypersensitive reactions or angioedema. At initial evaluation, blood pressure was 190/90 mmHg and hemoglobin 10,4 g/dL while the rest parameter was within normal limits. We given propofol and rocuronium to induce relaxation and facilitate intubation in surgery. Approximately 90 minutes after rocuronium injection, patient evolved angioedema across the face/area, tongue, and floor of the mouth. Patient also complained of not being able to talk. Soon after that, we give 10 mg of dexamethasone and 100 mg hydrocortisone to the patient. Within 60 minutes after hydrocortisone administration the patient shows/clinical improvement that marked by swelling began to decrease and the patient was able to speak again. Then we educate patient about angioedema and its alert.</p><p><strong>Conclusion: </strong>Anaphylaxis is a type of hypersensitivity response that take place to a particular allergen and mostly self-limited, but 11% of hypersensitive reaction require airway intervention. Most of anesthetic medication such as thiopental sodium, propofol, muscle relaxants, and etomidate may induce anaphylactic reaction during anesthesia induction. Discontinuation of underlying agent and airway control may prevent mortality and morbidity.</p>

Efficacy of Laryngeal Mask Airway Compared to Endotracheal Tube: A Randomized Clinical Trial

BackgroundIn patients under general anesthesia, the laryngeal mask airway (LMA) is a valuable alternative to endotracheal intubation to maintain the airway. In this study, we compared the efficacy of LMA with an endotracheal tube (ETT) in plastic and reconstructive surgeries over 2 h on thorax and abdomen under general anesthesia in Hazrat Fatemeh Hospital in Tehran, Iran, in 2020.MethodsThis randomized clinical trial was performed on a sample size of 80, randomly assigned to two groups. The main variables included the ease of placement, recurrent carbon dioxide content, arterial oxygen saturation, and laryngeal and tracheal spasm. In addition, the sub-variables entailed the mean duration of anesthesia, nausea and vomiting, sore throat, and abdominal distension. The obtained data were analyzed by the SPSS software version 25.ResultsIn the present study, 76 patients were female. Mean age, recurrent carbon dioxide, arterial oxygen saturation, laryngeal and tracheal spasm, the mean duration of anesthesia, nausea and vomiting, sore throat, and abdominal distension were not significantly different between the two groups.ConclusionsThe results of this study showed that the classic laryngeal mask could be used as a means of airway control in general anesthesia for long-term surgeries of more than 2 h.

Tracheal intubation practices and adverse events in trauma victims on arrival to trauma triage: A single centre prospective observational study.

Background and Aims:Trauma is one of the leading causes of global disease burden. Data on airway management in trauma patients from developing countries, particularly India is sparse. Hence, we planned a prospective observational study to assess the airway management practice patterns and associated complications.Methods:The study was conducted in trauma triage of a tertiary care hospital. Data was collected on all tracheal intubations occurring in trauma victims requiring definitive airway control, a detailed proforma including patient details, mode of injury, drugs used, intubation procedure, and complications were filled out for each patient.Results:We observed that the airway in trauma patients was primarily managed by non-anaesthesia speciality residents (426 patients); anaesthesia residents were primarily called for deferred or difficult intubations. The first attempt success rate of intubation by anaesthesia residents was significantly higher than speciality residents (P = 0.0001; 95% CI 9.02-24.66). Non-anaesthesia residents used midazolam in varying doses (3-12 mg) for intubation, whereas, rapid sequence intubation was the most common technique used by anaesthesia residents. Airway injuries were the most frequent complication observed in 32.8% of patients intubated by specialty residents compared to 5.9% of patients intubated by anaesthesia residents.Conclusion:The trauma triage is a high-volume area for frequent tracheal intubations which are manned by non-anaesthesia speciality teams. A number of factors related to the patient, staff, availability of airway equipment and unfavourable surroundings impact airway management and may explain the high incidence of airway complications, such as airway injuries in these trauma victims.

Emergency physician-performed emergency bronchoscopy in cardiac arrest patient due to acute foreign body airway obstruction.

As foreign body airway obstruction (FBAO) can be life-threatening, it has to be promptly diagnosed and treated. We report a case series of three patients presenting to the emergency department with cardiac arrest due to FBAO. In each case, ventilation was difficult due to high airway resistance. As FBAO was suspected, the emergency physician did a prompt flexible bronchoscopy to confirm the diagnosis and retrieve the foreign body. Flexible bronchoscopy is an important diagnostic and therapeutic tool for emergency airway management, and is a relatively safe procedure if performed by a trained personnel. The life-saving benefits of bronchoscopy outweigh the small risks of complications such as bleeding, desaturation and pneumothorax. In the three cases, the removal of the obstructing material led to immediate improvements in oxygenation and ventilation. The patients had return of spontaneous circulation after cardiopulmonary resuscitation and definite airway control.

Abstract No. : ABS1275: Efficacy of novel dual channel LMAGastro™ with colour coded pressure gauge in day care GI endoscopy procedures

Background &Aims:The aims and objectives were to evaluate the utility ofGastro™Laryngealmaskairway(LMA) for gastrointestinal(GI)endoscopic procedures for improvement of airway control, to prevent hypoxia andto avoid intubation.Methods:A prospective randomised observational study was conducted in 50 patients, 25 in each group for elective GI endoscopy procedures.Group G : LMA Gastro Group N : Nasal Cannula .All were observed for intraoperative hypoxia/any adverse events/endotracheal intubation. Inclusion criteriawere 18 -60 years, AmericanSocietyofAnesthesiologists(ASA) gradel,ll,lll,ModifiedMallampatiscorEclassIandII,supine/lateral position, Day care,,fasting. Exclusion criteriawere emergency procedure,notnil by mouth,prone position, pregnant and lactating females.Results:50 patients of ASAI,IIand III undergoing GI endoscopic procedure were divided into two groups. Gastro LMA and nasal prong groups;each having 25 patients. In Gastro™ LMA group, 1 patient (4%) required endotracheal intubation and in nasal prong group, 2 patients (8%) required endotracheal intubation. No postoperative complication was noted in any of the two groups.Conclusion:LMA Gastro™ airway is auser friendly device for the gastro physician and anaesthesiologists. It isa useful airway management tool for clinical use in day care GIendoscopic procedures.

Hemodynamics in Helicopter Emergency Medical Services (HEMS) Patients Undergoing Rapid Sequence Intubation With Etomidate or Ketamine.

Rapid sequence intubation (RSI) is performed by helicopter emergency medical services (HEMS) providers to establish airway control. Common induction agents are etomidate and ketamine, both touted to have relatively stable hemodynamic profiles. Limited data comparing these medications in the air medical setting exist. Compare administration of ketamine and etomidate on peri-intubation hemodynamics. A retrospective chart review of intubations performed by a HEMS program over 69 months was completed. Heart rate (HR) change, systolic blood pressure (SBP) change, and hypotension with etomidate or ketamine use were measured. There were 258 patients induced with etomidate and 48 with ketamine. Etomidate patients showed a +1.161% change in HR (SD ± 22.7) and -0.49% change in SBP (SD ± 25.0). Ketamine patients showed a -4.7% change in HR (SD ± 16.7) and 17.2% change in SBP (SD ± 43.4). The p-values for percentage change in HR and SBP between etomidate and ketamine were 0.0830 and 0.0018, respectively. Twenty-five episodes of postadministration hypotension occurred with etomidate, and two with ketamine (p=0.028). Both ketamine and etomidate are appropriate for intubation of HEMS patients. Ketamine was preferentially selected for hypotensive patients with statistically significant improvement in SBP. Although statistically significant, both ketamine and etomidate had relative low incidences of hypotension.

Chapter 14 - Neural control of the lower airways: Role in cough and airway inflammatory disease

Airway function is under constant neurophysiological control, in order to maximize airflow and gas exchange and to protect the airways from aspiration, damage, and infection. There are multiple sensory nerve subtypes, whose disparate functions provide a wide array of sensory information into the CNS. Activation of these subtypes triggers specific reflexes, including cough and alterations in autonomic efferent control of airway smooth muscle, secretory cells, and vasculature. Importantly, every aspect of these reflex arcs can be impacted and altered by local inflammation caused by chronic lung disease such as asthma, bronchitis, and infections. Excessive and inappropriate activity in sensory and autonomic nerves within the airways is thought to contribute to the morbidity and symptoms associated with lung disease.

AIRWAY MANAGEMENT IN LAPAROSCOPIC CHOLECYSTECTOMY - A COMPARATIVE ANALYSIS.

In this study, we aimed to compare supraglottic airway devices (Supreme and i-gel laryngeal mask) with tracheal tube with respect to airway control and efficiency in ventilation and oxygenation. The study included 325 patients of ASA I-II who underwent laparoscopic cholecystectomy. In group 1, the airway was secured using endotracheal intubation (115 patients). In group 2 (103 patients), LMA Supreme was applied, whereas i-gel mask was used for airway management in group 3 (107 patients). Monitoring parameters were recorded and compared using t-test, analysis of variance (ANOVA), Tukey's test and χ2-test. The following parameters were monitored: insertion time, number of attempts for device placement, oropharyngeal seal pressure, etc. Insertion time was longest in group 1 (14.7±1.65 s) as compared to group 2 (15.5±1.05 s) and group 3 (14.1±1.27 s); ANOVA test yielded a statistically significant difference (p<0.01). Insertion success rate was almost identical in all three groups (p=0.907, χ2-test). Comparison of oropharyngeal seal pressure between group 2 (35.95±2.92 cm H2O) and group 3 (36.47±1.43 cm H2O) yielded no statistical difference (p=0.314, t-test). Endotracheal tube, Supreme and i-gel laryngeal masks were shown to be equally efficient in airway management in laparoscopic cholecystectomy. All three devices enabled efficient ventilation and oxygenation despite certain pathophysiological changes associated with laparoscopy.

Sealing-type Three-cavities Ventilation Joint: A New Device in Painless Bronchoscopy

Background: To observe the clinical effect and safety of the sealing-type three-cavities ventilation joint in painless bronchoscopy. To compare the respiratory mechanics between I-gel laryngeal mask and tracheal tube-controlled breath during bronchoscopy. Methods: 200 patients underwent bronchoscopy were recruited and randomly assigned to general anesthesia group (group Ⅰ, n = 100) and local anesthesia group (group Ⅱ, n = 100). General anesthesia group were divided into two groups, the I-gel laryngeal mask combined with sealing-type three-cavities ventilation joint group group(n=50) and the endotracheal tube combined with sealing-type three-cavities ventilation joint group(n=50). Patients in Group I were adopted by I-gel laryngeal mask or endotracheal tube with the sealing-type three-cavities ventilation joint after the induction anesthesia with remifentanil, propofol and succinylcholine. In group II, patients were anaesthetized with lidocaine and followed by 2mg/ kg propofol iv, and spontaneous respirations were retained with nasal cannula. All patients’ vital signs, endoscopic related adverse reactions and arterial blood gas analysis were recorded during the procedure. Results: Group I showed little changes of vital signs (P &lt;0.05), and less adverse reaction such as the intraoperative hypoxia and intraoperative body movement (P &lt;0.05), and no significant decrease of oxygen partial pressure (P &lt;0.05). There is no significant difference in respiratory mechanics including tidal volume and airway pressure between two subgroups in group I(P&gt;0.05). Conclusion: Sealing-type three-cavities ventilation joint prevents the oxygen deficit and makes it possible for us to examine patients through bronchoscope under general anesthesia without gas leakage. Moreover, sealing-type three-cavities ventilation joint provides safe and effective airway control while it does not change respiratory mechanics in endotracheal tube group compared with I-gel laryngeal mask makes endotracheal tube an alternative solution in bronchoscope. Take all these in consideration, sealing-type three-cavities ventilation joint proves to be a feasible method in bronchoscope.