The application value of laryngeal mask airway general anesthesia in painless bronchoscopy and its influence on the sense of comfort and satisfaction

This study explores the applicability of general anesthesia with a laryngeal mask airway in painless bronchoscopy and its impact on the sense of comfort and satisfaction. Using the random number table method, we divided 101 elderly patients with respiratory disease who underwent bronchoscopy into two groups, with one group receiving intravenous general anesthesia (IVGA) and the other group receiving laryngeal mask airway general anesthesia (LMAGA). Their vital signs, including heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO2), were compared and we also examined their perioperative adverse effects and assessed the sense of comfort and satisfaction. There were no significant differences in vital signs, including HR, MAP and SpO2, between the two groups before anesthesia (T0). However, at T1 and T2, the HR of patients in the LMAGA group was significantly lower than that of the IVGA group. Additionally, the MAP and SpO2 levels in the LMAGA group were significantly higher than those in the IVGA group. The LMAGA group also demonstrated significantly shorter surgical duration and faster recovery from anesthesia than the IVGA group. Furthermore, the LMAGA group exhibited a significantly lower incidence of adverse effects and a notable increase in comfort and satisfaction compared to the IVGA group. LMAGA demonstrates a significant anesthetic effect in painless bronchoscopy, effectively improving the patient’s vital signs, reducing the duration of the operation and anesthetic recovery time, lowering the occurrence of perioperative adverse reactions, and enhancing the overall sense of comfort and satisfaction.

Bronchoscopy; Laryngeal mask airway general anesthesia; Intravenous general anesthesia; Anesthetic effect; Comfort and satisfaction

[1] GBD Chronic Respiratory Disease Collaborators. Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet Respiratory Medicine. 2020; 8: 585–596.

[2] Xie M, Liu X, Cao X, Guo M, Li X. Trends in prevalence and incidence of chronic respiratory diseases from 1990 to 2017. Respiratory Research. 2020; 21: 49.

[3] McLaughlin CW, Skabelund AJ, Easterling ER, Morris MJ. The safety and utility of fiberoptic bronchoscopy in the very elderly. Journal of Bronchology & Interventional Pulmonology. 2018; 25: 300–304.

[4] Tang H, Yuan Z, Li J, Wang Q, Fan W. The application of ambroxol hydrochloride combined with fiberoptic bronchoscopy in elderly patients with severe pneumonia. Medicine. 2022; 101: e28535.

[5] Thiam K, Ndiaye EHM, Touré NO, Dia Kane Y, Mbaye FBR, Cissé MF. Contribution of fiberoptic bronchoscopy in the diagnosis of pulmonary dragging. Clinical Pulmonary Disease Review. 2016; 72: 281–287. (In French)

[6] Ma W, Hu J, Yang M, Yang Y, Xu M. Application of flexible fiberoptic bronchoscopy in the removal of adult airway foreign bodies. BMC Surgery. 2020; 20: 165.

[7] Geyik FD, Dogruyol T, Kahraman S, Arslan G, Saracoglu KT, Demirhan R. Short-term outcomes of fiberoptic bronchoscopy-guided resection and anastomosis control in thoracic surgery. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 2022; 32: 673–676.

[8] Biciusca V, Popescu IAS, Trasca DM, Olteanu M, Stan IS, Durand P, et al. Diagnosis of lung cancer by flexible fiberoptic bronchoscopy: a descriptive study. Romanian Journal of Morphology and Embryology. 2022; 63: 369–381.

[9] Wang J, Yang S, Chen J, Chen Z. Painless fiberoptic bronchoscopy in patients with COVID-19: analysis of 33 cases. Journal of Southern Medical University. 2021; 41: 562–566. (In Chinese)

[10] Jiang NN, Wang DY, Xi MM, Luan XG, Jiang MJ, Li F, et al. Retrospective study of fiberoptic bronchoscopy airway lavage in the treatment of extremely severe burn patients with severe inhalation injury. Chinese Journal of Burns. 2020; 36: 252–259. (In Chinese)

[11] Zhang J, Liu JB, Zeng FN, Ren Q, Lin HL, Jian LL, et al. Safety and efficacy of dexmedetomidine hydrochloride combined with midazolam in fiberoptic bronchoscopy in children: a prospective randomized controlled study. Chinese Journal of Contemporary Pediatrics. 2021; 23: 981–986.

[12] Alon D, Pertzov B, Gershman E, Frishman M, Rahman NA, Rosengarten D, et al. The safety of laryngeal mask airway-assisted bronchoscopy versus standard nasal bronchoscopy. Respiration. 2017; 93: 279–284.

[13] Xu K, Zhang Y, Cui Y, Tian F. Patient-reported outcomes of laryngeal mask anesthesia in thoracoscopic pulmonary wedge resection: a randomized controlled study. Thoracic Cancer. 2022; 13: 3192–3199.

[14] Bao J, Zhou L, Liu G, Tang J, Lu X, Cheng C, et al. Current state of care for the elderly in China in the context of an aging population. BioScience Trends. 2022; 16: 107–118.

[15] Bhushan S, Huang X, Duan Y, Xiao Z. The impact of regional versus general anesthesia on postoperative neurocognitive outcomes in elderly patients undergoing hip fracture surgery: a systematic review and meta-analysis. International Journal of Surgery. 2022; 105: 106854.

[16] Qanash S, Hakami OA, Al-Husayni F, Gari AG. Flexible fiberoptic bronchoscopy: indications, diagnostic yield and complications. Cureus. 2020; 12: e11122.

[17] Alhomary M, Ramadan E, Curran E, Walsh SR. Videolaryngoscopy vs. fibreoptic bronchoscopy for awake tracheal intubation: a systematic review and meta-analysis. Anaesthesia. 2018; 73: 1151–1161.

[18] Ozturk MC, Kucuk M, Ugur YL, Comert B, Gokmen AN, Ergan B. The safety of fiberoptic bronchoscopy in airway pressure release ventilation mode in critically ill patients with severe acute respiratory distress syndrome: a preliminary study. Turkish Thoracic Journal. 2022; 23: 403–408.

[19] Cobo P, Vetter-Laracy S, Beltran E, Peña-Zarza JA, Figuerola J, Osona B. Utility of fiberoptic bronchoscopy for difficult airway in neonates. The Journal of Maternal-Fetal & Neonatal Medicine. 2021; 34: 2754–2757.

[20] Pertzov B, Krasulya B, Azem K, Shostak Y, Izhakian S, Rosengarten D, et al. Dexmedetomidine versus propofol sedation in flexible bronchoscopy: a randomized controlled trial. BMC Pulmonary Medicine. 2022; 22: 87.

[21] Gautam G, Khera D, Lodha R, Kabra SK. Sedation in pediatric bronchoscopy: propofol versus fentanyl. Indian Pediatrics. 2020; 57: 483–484.

[22] Yu H, Chen L, Yue C, Xu H, Cheng J, Cornett EM, et al. Effects of propofol and sevoflurane on T-cell immune function and Th cell differentiation in children with SMPP undergoing fibreoptic bronchoscopy. Annals of Medicine. 2022; 54: 2573–2579.

[23] Tekeli AE, Oğuz AK, Tunçdemir YE, Almali N. Comparison of dexmedetomidine-propofol and ketamine-propofol administration during sedation-guided upper gastrointestinal system endoscopy. Medicine. 2020; 99: e23317.

[24] Zhu H, Sun Y, Wang T, Wu Z. Alfentanil and propofol induced anesthesia for patients with huge endotracheal tumor undergoing fiberoptic bronchoscopic interventional therapy: case report. Translational Cancer Research. 2022; 11: 2946–2952.

[25] Zhou Y, Wu W, Zhu Y, Lv X, Liu J. Inhibition of stress and spontaneous respiration: efficacy and safety of monitored anesthesia care by target-controlled infusion remifentanil in combination with dexmedetomidine in fibreoptic bronchoscopy for patients with severe tracheal stenosis. Frontiers in Medicine. 2022; 9: 972066.

[26] Samal S, Kumar M, Patro M, Panigrahy S, Kartheek B. Comparison between intravenous dexmedetomidine and spray as you go with 4% lignocaine versus intravenous fentanyl and transtracheal injection of 4% lignocaine for awake nasotracheal intubation with flexible vedioscope—a randomized single-blind prospective study. Anesthesia: Essays and Researches. 2021; 15: 213.

[27] López Castilla JD, Sánchez Fernández N, Charlo Molina MT, Vázquez Florido A, Murillo Pozo MA, Sánchez Ganfornina I, et al. Midazolam/fentanyl vs. propofol/remifentanil in immediate postoperative with short-term mechanical ventilation. Pediatric Yearbook. 2022; 96: 115–121.

[28] Chilkoti G, Agarwal M, Mohta M, Saxena A, Sharma C, Ahmed Z. A randomised preliminary study to compare the performance of fibreoptic bronchoscope and laryngeal mask airway CTrach (LMA CTrach) for visualisation of laryngeal structures at the end of thyroidectomy. Indian Journal of Anaesthesia. 2020; 64: 704.

[29] Karaaslan E, Akbas S, Ozkan AS, Colak C, Begec Z. A comparison of laryngeal mask airway-supreme and endotracheal tube use with respect to airway protection in patients undergoing septoplasty: a randomized, single-blind, controlled clinical trial. BMC Anesthesiology. 2021; 21: 5.

[30] Li X, Wang X, Zhao Y, Jiang Z, Lv X, Nie X, et al. Incidence of postoperative sore throat after using a new technique of insertion of a second generation laryngeal mask airway. European Journal of Anaesthesiology. 2021; 38: 285–293.