Supraglottic Airway Versus Endotracheal Tube During Interventional Pulmonary Procedures

A Retrospective Study

Kyle M. Behrens; Richard E. Galgon

Disclosures

BMC Anesthesiol. 2019;19(196) 

In This Article

Background

The field of interventional pulmonology (IP) is rapidly expanding as new technologies and techniques are invented with nearly 500,000 bronchoscopies being performed in the United States each year.[1,2] Sicker patients with high risk co-morbidities and lung pathology are now 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 procedures, which can even be administered/directed by the interventionalist. However, 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; however, 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). Over time, anesthesia providers and interventionalist with experience using SGAs have allowed their scope to be advanced. Advantages of using SGAs (compared to ETT) include (1) quicker and easier placement, (2) reduction in neuromuscular blocking drug (NMBD) usage, residual paralysis, hemodynamic variability, anesthetic requirement for device placement, emergence coughing, and laryngeal and subglottic trauma, and (3) preservation of laryngeal competence and mucociliary function.[5] In a report in 2016, Arevalo-Ludena et al reported observing no difference in leakage between SGAs and ETT during bronchoscopic lung volume reduction procedures.[6] However, data on the use of SGAs for other procedures remains lacking.

Over the course of the last five to ten years, the scope of SGA usage at our institution for IP procedures has grown, particularly because the use of an SGA for IP procedures affords versatility over use of an ETT in selected patients by providing the ability to (1) perform a complete airway exam, including visualization of glottic structures, (2) biopsy more proximal lymph nodes, and (3) manipulate endobronchial devices more easily through the airway conduit. The purpose of our study was to characterize the use of SGA versus ETT, and secondarily anesthetic maintenance patterns, during IP procedures at our institution.

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