A retrospective observational study of anesthesia management during the flexible or rigid bronchoscopy in patients with central airway obstruction: Safety application of muscle relaxants and the traditional Low-frequency ventilation

Abstract Background: Bronchoscopy treatments of central airway obstruction (CAO) under general anesthesia are high-risky procedures, and posing a giant challenge to the anesthesiologists. We summarized and analyzed our clinical experience in anesthesia management in patients with CAO undergoing flexible or rigid bronchoscopy, including the use of muscle relaxants , the traditional Low-frequency ventilation.Methods: Clinical data of 375 patients with CAO who underwent urgent endoscopic treatments in general anesthesia from January 2016 to October 2019 were retrospectively reviewed. The use ratio of skeletal muscle relaxants, dose of skeletal muscle relaxants used, the incidence of perioperative adverse events, adequacy of ventilation and gas exchange, post-operative recovery between rigid bronchoscopy and flexible bronchoscopy therapy, and risk factors for postoperative ICU admission were evaluated.Results: There was a high usage rate (96.5%) of skeletal muscle relaxants in patients with CAO who underwent either flexible bronchoscopy or rigid bronchoscopy therapy and a higher dosage of skeletal muscle relaxants used in rigid bronchoscopy compared with flexible bronchoscopy therapy. This procedure had a low incidence of perioperative adverse events, with no significant difference between flexible and rigid bronchoscopy therapy. Sufficient ventilation was successfully established using the traditional Low-frequency ventilation both in flexible and rigid bronchoscopy group. There was a low mortality (0.8%) during the post-operative recovery, and the higher grade of American Society of Anesthesiologists (ASA) and obvious dyspnea or orthopnea were the independent risk factors for postoperative ICU admission.Conclusion: The muscle relaxants and low-frequency traditional ventilation can be safely used both in flexible and rigid bronchoscopy treatments in patients with CAO These results may provide strong clinical evidence for optimizing the anesthesia management of bronchoscopy for such patients.