To acertain the safety and efficacy of the laryngeal mask airway (LMA) for flexible diagnostic and interventional bronchoscopy when general anesthesia is utilized.
We prospectively evaluated the use of the LMA in 70 procedures (400-500 bronchoscopies annually) over 4 years. Co-morbidities, diagnoses, intraoperative measurements, and outcomes were reviewed. Procedures included diagnostic bronchoscopy, biopsies, dilatations, stent insertion and energy ablation procedures.
Goals of the procedure were uniformly achieved. Anesthesia emergence was uneventful. Unless the patients were already in hospital, all procedures were performed as outpatients except the stent insertions. Two patients were admitted for observation overnight. No aspiration was recognized. Mean systolic blood pressure was 131, minimum SaO2 was 98%, and mean end tidal CO2 was 37. We saw no adverse intraoperative events. Laryngospasm occurred in 31% of patients and was easily treated with deepening of inhalational anesthesia or intravenous asuccinyl choline with no adverse sequelae.
While most patients tolerate awake bronchoscopy, general anesthesia permits safe endoscopy when conscious sedation is inadequate or deemed unsafe. Use of the LMA allows a full range of flexible bronchoscopic procedures as well as an unobstructed view of the entire airway from the glottis (when the airway may be obscured by an endotracheal tube) to the distal airways. LMA has been shown to reduce recovery time, create less bronchospasm and attenuate neurocirculastory responses compared to endotracheal intubation. Use of the LMA for bronchoscopy requiring general anesthesia, both diagnostic and interventional, is safe, convenient and affords access to the entire trachebronchial tree.
Use of the LMA permits unobstructed access to the entire airway, and may be the airway of choice for bronchoscopy under general anesthesia.
N.J. Snow, None.