Anaesthesia and peri-interventional morbidity of rigid bronchoscopy: A retrospective analysis

Peer review under responsibility of Egyptian Society of Anesthesiologists.

Figures & data

Table 1 Indication and contraindications for rigid bronchoscopy.

Indications for rigid bronchoscopy

• Management of massive haemoptysis • Treatment of tracheobronchial stenosis • Foreign body removal • Tumour resection • Deep bronchial wall biopsy

Contraindications for rigid bronchoscopy

• Unstable cervical spine • Severe maxillofacial trauma or deformity • Obstructing oral or laryngeal disease

Adapted from ERS/ATS statement on interventional pulmonology, 2002 [1].

Table 2 Demographic data of patients undergoing rigid bronchoscopy procedures.

Patient characteristics	Total (N = 90)	TIVA (N = 73)	Volatile (N = 17)	P value
Age (years)	58.28 ± 15.40	59.30 ± 14.25	53.88 ± 19.49	0.193
BMI	20.97 ± 4.12	20.95 ± 4.17	21.07 ± 4.07	0.923
Gender
Male	62.2%	64.4%	52.9%	0.381
Female	37.8%	35.6%	47.1%
Ethnicity
Chinese	83.3%	84.9%	76.5%	0.126
Malay	6.7%	8.2%	0%
Indian	3.3%	2.7%	5.9%
Others	6.7%	4.1%	17.6%
ASA
2	50.0%	49.3%	52.9%	0.868
3	48.9%	49.3%	47.1%
4	1.1%	1.4%	0%
Medical history
Diabetes	10.0%	8.2%	17.6%	0.243
Hypertension	23.3%	28.8%	0%	0.012^*
IHD	11.1%	13.7%	0%	0.106
CVA	3.3%	4.1%	0%	0.395
AF	1.1%	1.4%	0%	0.627
Bronchiectasis	42.2%	43.8%	35.3%	0.521
COPD	11.1%	9.6%	17.6%	0.341
Asthma	4.4%	5.5%	0%	0.323
Tuberculosis	26.7%	23.3%	41.2%	0.133
Lung Abscess	3.3%	4.1%	0%	0.395
Cirrhosis	3.3%	1.4%	11.8%	0.032^*
Cancer	57.8%	60.3%	47.1%	0.320
Metastasis	20.0%	21.9%	11.8%	0.424

TIVA = total intravenous anaesthesia, BMI = body mass index, ASA = American Society of Anesthesiologists physical status classification system, IHD = ischemic heart disease, CVA = cerebrovascular accident, AF = atrial fibrillation, COPD = chronic obstructive pulmonary disease.

Data presented as Mean±SD or percentages.

* P < 0.05 is significant.

Table 3 Procedure types, ventilation methods and medications received intra-operatively.

Parameters	Total (N = 90)	TIVA (N = 73)	Volatile (N = 17)	P value
Procedures
Laser	64.4%	68.5%	47.1%	0.096
Stent insertion	57.8%	60.3%	47.1%	0.320
Dilation	36.7%	35.6%	41.2%	0.668
Foreign body removal	3.3%	4.1%	0%	0.395
Biopsy	12.2%	8.2%	29.4%	0.016^*
Stent removal	3.3%	4.1%	0%	0.395
Surgery duration (minutes)	64.90 ± 29.23	64.04 ± 27.86	68.59 ± 35.24	0.566
Ventilation methods
Spontaneous	87.8%	90.4%	76.5%	0.114
IPPV	12.2%	9.6%	23.5%	0.114
Intra-op medication
Local anaesthetics	56.7%	60.3%	41.2%	0.152
Morphine	1.1%	0%	5.9%	0.037^*
Fentanyl	20.0%	15.1%	41.2%	0.015^*
Remifentanil	53.3%	63.0%	11.8%	0.000^*
Alfentanil	27.8%	23.3%	47.1%	0.049^*
Dexamethasone	74.4%	72.6%	82.4%	0.406
Antibiotics	18.9%	21.9%	5.9%	0.128
Inotropes	7.8%	9.6%	0%	0.184

TIVA = total intravenous anaesthesia, IPPV = intermittent positive pressure ventilation.

Data presented as Mean ± SD or percentages.

* P < 0.05 is significant.

Table 4 Preoperative and postoperative comparison of arterial blood gas, pulse oximetry and pulmonary function test measurements.

Parameters	Total (N = 90)	TIVA (N = 73)	Volatile (N = 17)	P value
Arterial blood gas
Pre-op O2	92.08 ± 40.02	94.81 ± 41.56	70.76 ± 12.79	0.210
Post-op O2	121.46 ± 76.72	120.56 ± 83.73	125.75 ± 32.68	0.905
Pre-op CO2	39.95 ± 10.77	40.67 ± 11.09	34.34 ± 5.94	0.220
Post-op CO2	45.58 ± 15.79	44.05 ± 15.87	52.25 ± 7.62	0.322
Pre-op pH	7.44 ± 0.08	7.44 ± 0.08	7.45 ± 0.04	0.727
Post-op pH	7.41 ± 0.10	7.43 ± 0.09	7.30 ± 0.10	0.021^*
Pulse oximetry
Pre-op SpO2	97.57 ± 2.11	97.67 ± 2.17	97.12 ± 1.80	0.334
Lowest SpO2	93.06 ± 5.94	92.81 ± 6.37	94.12 ± 3.48	0.416
Pulmonary function test
Pre-op FEV1	1.42 ± 0.47	1.37 ± 0.49	1.66 ± 0.24	0.174
Post-op FEV1	1.80 ± 0.51	1.77 ± 0.59	1.88 ± 0.23	0.644
Pre-op FVC	1.96 ± 0.64	1.92 ± 0.66	2.13 ± 0.49	0.466
Post-op FVC	2.35 ± 0.62	2.19 ± 0.56	2.73 ± 0.60	0.034^*
Pre-op FRC	73.48 ± 12.84	72.22 ± 11.92	80.00 ± 16.54	0.178
Post-op FRC	77.32 ± 11.93	80.18 ± 9.16	70.87 ± 15.36	0.065
Pre-op PEFR	3.52 ± 1.13	3.50 ± 1.12	3.63 ± 1.30	0.838
Post-op PEFR	4.58 ± 1.29	4.60 ± 1.33	4.51 ± 1.31	0.884

TIVA = total intravenous anaesthesia, pH = arterial blood pH, FEV1 = forced expiratory volume in 1 s, FVC = forced vital capacity, FCR = functional residual capacity, PEFR = peak expiratory peak flow rate. Data presented as Mean ± SD.

* P < 0.05 is significant.

Table 5 Mechanical and Systemic peri-interventional complications of rigid bronchoscopy comparing TIVA vs. Volatiles.

Complications	Total (N = 90)	TIVA (N = 73)	Volatile (N = 17)	P value
Mechanical complications
Stent dislodge	1.1%	1.4%	0%	0.627
Laryngospasm	1.1%	1.4%	0%	0.627
Bleeding	2.2%	2.7%	0%	0.490
Tooth dislodge	1.1%	1.4%	0%	0.627
Change to FOB: failed to locate lesion	2.2%	2.7%	0%	0.490
Systemic complications
Hypotension	13.3%	15.1%	5.9%	0.316
Hypertension	3.3%	1.4%	11.8%	0.032^*
Arrhythmia	4.4%	5.5%	0%	0.323
AMI	2.2%	0%	11.8%	0.003^*
Hypoxia	4.4%	5.5%	0%	0.323
Carbon dioxide retention	3.3%	4.1%	0%	0.395
Acute pulmonary oedema	2.2%	2.7%	0%	0.490
Pneumothorax	3.3%	0%	17.6%	0.000^*
Pneumonia	5.6%	6.8%	0%	0.267
Pulmonary haemorrhage	1.1%	1.4%	0%	0.627
Infection	1.1%	1.4%	0%	0.627
Re-admission within 3mth	10.0%	12.3%	0%	0.127
Tracheostomy for post-op long term ventilation	1.1%	1.4%	0%	0.627
Delirium	2.2%	2.7%	0%	0.490
Death	3.3%	4.1%	0%	0.395

TIVA = total intravenous anaesthesia, AMI = acute myocardial infarction, FOB = fibre-optic bronchoscopy. Data presented as percentages.

* P < 0.05 is significant.