The Safety of Laryngeal Mask Airway-Assisted Bronchoscopy versus Standard Nasal Bronchoscopy

Background: The use of laryngeal mask airway (LMA) for fiberoptic bronchoscopy was first described in 1982. The LMA was found to be beneficial in operator view, flexibility, and also in maintaining stable oxygen saturation. Despite its advantages, the use of LMA has not become widespread. Objective: The aim of this paper was to evaluate the safety of LMA-assisted bronchoscopy compared to standard nasal bronchoscopy. Methods: We conducted a prospective randomized trial. The study group included 105 patients prospectively randomized to undergo either LMA-assisted (53 patients) or standard nasal bronchoscopy (52 patients). The data collected included continuous monitoring of respiratory and hemodynamic parameters and medication doses. Results: The LMA group had a significantly lower percentage of desaturation (pulse oximetry saturation [ SpO(2)] < 88%) events compared to the non-LMA (NLMA) group (37 vs. 63.4%; p = 0.008). The median percentage of time with SpO2 > 88%, from the total procedure time, was 100% (IQR 98-100) in the LMA group and 98% (IQR 96-98) in the NLMA group (p = 0.003). Sedation in the LMA group required significantly higher doses of propofol (p < 0.001). The mean systolic blood pressure values were significantly lower in the LMA group, but this difference did not result in a higher percentage of clinically significant hypotension. Conclusion: The use of LMA allows for better airway support, stable oxygen saturation, and a more convenient port of entry during flexible fiberoptic bronchoscopy. These results, together with the known advantages of the laryngeal mask, should lead to more widespread use in the evolving field of interventional pulmonology, in particular in high- risk patients and complicated procedures. (C) 2017 S. Karger AG, Basel