Anesthesia management and challenges during interventional pulmonology procedures for central airway obstructions

Abstract

Aim: Central airway obstructions (CAO) are one of the main reasons for morbidity and mortality, often originate in the lungs, and are generally unresectable. Interventional airway procedure is a preferred method in these cases. This study aimed to analyze anesthesia management in patients undergoing interventional procedures for CAO. We aimed to highlight the problem and solutions that may be encountered in such cases. Material and Method: The data of 49 patients who had interventional airway procedure were analyzed retrospectively. Patients’ demographic data, type of interventional procedures, localization of the lesion, and duration of the procedure were analyzed. Vital parameters and arterial blood gases (ABG) levels had been recorded before anesthesia induction (T1), after rigid bronchoscope insertion (T2), 20th-minute of the procedure (T3), after extubation (T4), and in the postoperative care unit (T5). Results: The mean age was 57.90±11.99 years. The mean duration of the procedure was 34.75±15.62 minutes. The majority of the patients had American Society of Anesthesiologists (ASA) III-IV physical status. CAOs were mostly found in the main bronchus. Tumors debulking, biopsy, mechanical dilatation, argon plasma coagulation, and mechanical tumor resection were the most performed procedures. Stent insertion was performed in 3 (6.1%) patients. Two patients (4.1%) had bleeding, 3 (6.1%) patients had desaturation, and 1 (2.1%) patient had atrial fibrillation. Conclusion: Interventional airway procedures are frequently used for high risk patients with CAO and comorbidities. Detailed preoperative evaluation, periprocedural teamwork, and close hemodynamic and ABG follow-up are keys to success.