What is the key question?

• There is a paucity of published data regarding the optimal type of anesthesia and ventilation strategies during rigid bronchoscopy.
• This study evaluated the role of rigid bronchoscopy with spontaneous assisted breathing and total intravenous anesthesia.

What is the bottom line?

• In a retrospective analysis of 55 patients the authors suggest that therapeutic rigid bronchoscopy can be safely performed with total intravenous anaesthesia and spontaneous assisted ventilation in patients with central airway obstruction, significant comorbidities and a high ASA class.
• 90% of procedures were performed for malignant disease and 90% of patients had an ASA class III or IV.
• Of the 79 procedures, 18 (23%) utilized volatile inhalational anaesthetics during the induction of anaesthesia.
• Propofol infusion was used in all cases with additional intermittent injections as needed.
• Neuromuscular blockade (NMB) was avoided in 60 (76%) procedures. In the 19 procedures requiring NMB, in 6 instances it was only given during induction.
• The most common adverse events were intraoperative hypoxemia (67%) and hypotension (77%). Intraoperative hypoxemia was associated with stent placement, use of cautery devices (where low FI02 is required) and longer procedure duration.
• Major bleeding and postoperative respiratory failure occurred in 3.8% and 5.1% respectively.
• There was no intraoperative mortality or cardiac dysrhythmias.
• The 30 day mortality was 7.6% and was associated with older age, inpatient status, congestive heart failure, home oxygen use and procedural duration.
• The majority of patients (94%) were discharged home.

Why read on?

• The authors further discuss predictors of adverse outcomes including the duration of procedure in patients undergoing therapeutic rigid bronchoscopy.