Anesthesia Management in Patients With Central Airway Stenosis Undergoing Bronchoscopy Treatments - Safety Application of Muscle Relaxants and the Traditional Low-frequency Ventilation : A Retrospective Observational Study

Abstract

Background: Bronchoscopy treatments of central airway stenosis (CAO) under general anesthesia are high-risky procedures, and posing a giant challenge to the anesthesiologists. The aim of this research was to estimate the safety application of muscle relaxants and the traditional Low-frequency ventilation in patients with central airway stenosis undergoing bronchoscopy treatments under general anesthesia by summarizing our clinical experience.Methods: Clinical data of 375 patients with CAO who underwent urgent endoscopic treatments from January 2016 to October 2019 were retrospectively reviewed. The use ratio of skeletal muscle relaxants, dose of fentanyl and skeletal muscle relaxants used between rigid bronchoscopy compared with flexible bronchoscopy therapy, the incidence of perioperative adverse events, adequacy of ventilation and gas exchange, post-operative recovery 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 there is a higher dosage of analgesic and 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 bronchoscopy 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 ASA and obvious dyspnea or orthopnea were the independent risk factors for postoperative ICU admission. Conclusion: The use of proper dosage of muscle relaxants is indispensable and safe in patients with CAO undergoing bronchoscopy treatments and the traditional Low-frequency ventilation also can be used in this procedure safely.