Comparison of iGel and THRIVE on Bronchoscopic Interventions

THRIVE and iGEL were applied for maintain oxygenation in bronchoscopic interventions which could not performed with an endotracheal tube. Unlike the nasal cannula with THRIVE, the tips of iGel are located in upper esophagi, it may affect the postoperative swallowing, especially for the aged group. However, the bronchoscopic approach may be easier for an established route to vocal cords. With shared airway for ventilation and interventions, CO2 elimination is hardly monitored besides the risk of desaturation.

In this study, THRIVE or iGel was planned to be randomized used for bronchoscopic interventions in an adult group (age 20-65) and an aged group (age over 65). The difficulties to approach vocal cords, the responses to spay of local anesthetics including cough or spasm, the CO2 elimination, the hemodynamic changes, and the effects on postoperative recovery are compared between THRIVE and iGel groups.

• The responses to bronchoscopic insertion for bronchoscopic interventions such asTBNA, Cryotherapy, etc. (Procedure), also known as hemodynamic and ventilatory responses from insertion of broncoscopy to the end of bronchoscopic interventions: cough response, the changes of BP, HR, SpO2, Trans dermal CO2 during bronchoscopic interventions
• postoperative recovery (Procedure): anesthetic recovery in postoperative care unit recovery of swallowing by questionnaire in POD1

Primary outcomes

• difficulty of bronchoscopic approach [from bronchoscopic insertion to visualize vocal cords]: time from insertion to visualize vocal cord, records of manipulations if applied
• response to spraying local anesthetics by bronchoscopy [from visualizng vocal cords to complete local anesthetic spray in trachea and main bronchi]: the status of vocal cords visualized (relaxed, closed, relaxed but close with spray of local anesthetics); cough scale during bronchoscopic insertion and spray of local anesthetics

Secondary outcomes

• hemodynamic changes [from bronchoscopic insertion to 20 minutes after completion of local anesthetic spraying]: changes on MAP (mmHg)
• cough scale [from bronchoscopic insertion to the end of procedure]: cough intensity X times
• SPO2 [every 5 minutes from bronchoscopic insertion to the end of procedure]: pulse oximeter, hemoglobin saturation (%)
• Transdermal CO2 [every 5 minutes from bronchoscopic insertion to the end of procedure]: data obyenied from transdermal CO2 (mmHg)
• postanesthetic recovery [from admission to PACU to discharge from PACU]: time stay in postoperative care unit (minutes)

Other outcomes

• EAT-10 questionnaire (score):0-40 [preoperative and postoperative day 1]: EAT-10 for postbronchoscopic swallowing dysfunction, from 0 (normal swallowing) to 40 (extreme difficulty on swallowing)

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* plan to receive bronchoscopic interventions with total intravenous anesthesia

Exclusion Criteria:

* awake bronchoscopy pregnancy

• Fu-Chang Tsai, Study chair, National Taiwan University Hospital