SESSION TYPE: Pleural Disease
PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM
PURPOSE: To describe and assess the use of laryngeal mask airway (LMA) with spontaneous respirations as an alternative to both moderate sedation without airway control and to general anesthesia with double-lumen endotracheal tube for pleuroscopy.
METHODS: After IRB approval we reviewed cases of pleuroscopy performed by the interventional pulmonary service at the Michael E. Debakey VA Medical Center from August 2009 through February 2012, identifying those who were done using an LMA with deep sedation and spontaneous breathing. Demographic and clinical data were abstracted and analyzed.
RESULTS: Sixteen pleuroscopies were performed using LMA with spontaneous breathing during the study period. Patients were all male with a mean age of 62 years (range 53 to 71). Significant comorbidities included: OSA (12%), COPD (19%), CAD (38%), and overweight or obesity (56%). The most common indications for pleuroscopy in our cohort were undiagnosed pleural effusion (87%) or pleural masses (18%). Talc-pleurodesis was only performed in one patient. The obtained diagnoes were: non-specific pleural inflammation (n=8), mesothelioma (n=4), lung cancer (n=1), multiple myeloma (n=1), and tuberculosis (n=1). Adequate lung collapse was achieved in 81% of patients, while 18% had severe adhesions preventing adequate collapse. Nevertheless, adhesions only prevented biopsies in 1 case. The mean procedure time was 62 minutes (range 35 to 119), with a mean recovery time (defined as time from the end of the procedure to leaving the PACU) of 148 minutes (range 86 to 359). Complications were rare except for mild intraoperative hypotension not requiring specific measures (81%). One patient vomited and aspirated one hour postoperatively requiring reintubation.
CONCLUSIONS: LMA with deep sedation and spontaneous breathing is an effective and safe alternative to moderate sedation with local anesthesia or general anesthesia with single lung ventilation for pleuroscopy.
CLINICAL IMPLICATIONS: Using LMA with deep sedation and spontaneous breathing for pleuroscopy procedures may offer better sedation and analgesia with superior airway control than moderate sedation with less difficulty and risk than general anesthesia with dual-lumen endotracheal intubation.
DISCLOSURE: The following authors have nothing to disclose: Donald Lazarus, Juan Iribarren, Sheila Austria, Nina Castro, Edwin Suarez, Prasad Atluri, Mona Sarkiss, Charlie Lan, Roberto Casal
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