SESSION TITLE: Bronchoscopic Training and Approaches
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Sunday, October 27, 2013 at 10:45 AM - 11:45 AM
PURPOSE: To evaluate the safety, efficacy profile, and outcomes of the Laryngeal Mask Airway (LMA) use in convex and radial probe EBUS bronchoscopy and compare them to cases in which no airway was used.
METHODS: A limited retrospective, single center analysis was performed utilizing the IP database and OP surgical records. Two hundred consecutive advanced fiberoptic bronchoscopic cases, beginning in June 2010, were selected based on the following inclusion criteria: patients undergoing bronchoscopy using convex probe EBUS for centrally located lesions and radial probe EBUS for peripherally located lesions. This yielded 100 cases each in the "LMA" and "no airway" group. The following parameters were compared: demographic data, sedation used, hypoxic episodes, procedure time, and complications.
RESULTS: Demographic comparisons (LMA vs no airway) showed no significant difference in age (61.8y vs. 60.1y), height (66.88 in vs. 67.17 in), or weight (194.94 lbs vs. 180.56 lbs) between the two groups. The LMA group, however, did have a statistically higher BMI (30.75 vs. 28.10, p=0.042) when compared. Sedation during the procedure showed no difference with the use of fentanyl (238.5 mcg vs. 220.8 mcg) or diphenhydramine (19.0 mg vs. 17.5 mg). The LMA group did use a statistically higher dose of midazolam (12.6 mg vs. 10.9 mg, p=0.021). The overall procedure time did not vary between the two groups (45.1 min vs 42.3 min). Complications in the "LMA group" included: one hypoxic episode (SpO2<89) during the bronchoscopy, one episode of severe nausea and vomiting, and an episode of bleeding related to the bronchoscopic procedure. Complications in the "no airway group" included: one hypoxic episode (SpO2<89) during the bronchoscopy, 3 patients with transient desaturation (SpO2<89) post-bronchoscopy, and one pneumothorax. Consequently, the LMA appears effective in patients who are obese, useful for short procedures such as convex probe EBUS and for longer procedures such as radial probe EBUS.
CONCLUSIONS: LMA is a safe device to use during EBUS bronchocopy. While more sedation might be required during the use of the LMA, it is associated with fewer desaturations post-procedure.
CLINICAL IMPLICATIONS: LMA use during EBUS bronchoscopy may be an acceptable alternative to not using an airway. More data is needed to confirm fewer desaturations and better patient tolerance with LMA use. As a result we will be conducting a randomized prospective trial to assess the benefits of the LMA vs. no airway vs. ETT tube use.
DISCLOSURE: The following authors have nothing to disclose: Praveen Chenna, Andrea Loiselle, Daniel Brown, David Misselhorn, Alexander Chen
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