The efficacy and the safety of supraglottic airway in therapeutic procedure of trachea via flexible bronchoscopy compared with endotracheal intubation.

Background: Flexible bronchoscopy is frequently employed for therapeutic interventions in tracheal lesions, but airway management during these procedures is challenging due to the need to share the airway for both ventilation and instrumentation. Endotracheal intubation, while providing a secure airway, often requires repeated insertion and removal of the tube to allow for bronchoscopic access. Additionally, the narrower internal diameter of the endotracheal tube can limit the maneuverability of the bronchoscope, making procedures more technically demanding. In contrast, the supraglottic airway (SGA)-originally developed by an anesthesiologist known as laryngeal mask-is a less invasive device that sits above the larynx and forms a seal around the glottic opening to allow for effective ventilation. SGAs typically have a wider lumen and do not require repeated placement during procedures, offering a more convenient and potentially safer conduit for flexible bronchoscopy. Despite these advantages, direct comparative evidence on the safety and efficacy of SGA vs endotracheal intubation in this context remains lacking.

Methods: We reviewed charts and perioperative data regarding patients who underwent tracheal therapeutic procedures using flexible bronchoscopy under general anesthesia at Taipei Veterans General Hospital between 2019 and 2024. The primary outcome was the total number of repeated airway manipulations required. Secondary outcomes included oxygenation, ventilation, length of hospital stay, and procedure-related complications.

Results: A total of 65 procedures were analyzed. There was a significantly higher proportion of female patients in the SGA group (67.7%) compared with the endotracheal intubation group (22.9%, p < 0.001). Mann-Whitney U tests revealed a significant reduction in the requirement for repeated airway manipulations with the SGA compared with endotracheal intubation ( p < 0.001). The median lowest oxygen saturation was higher with SGA (97% vs 94%, p = 0.001), while end-tidal carbon dioxide (EtCO 2 ) levels were comparable (45 vs 44 mmHg, p = 0.94). In addition, patients in the SGA group were weaned from mechanical ventilation earlier and had significantly shorter hospital stays (5.5 vs 30 days, p < 0.001).

Conclusion: Compared with endotracheal intubation, the SGA is an effective alternative for airway management during therapeutic tracheal procedures using flexible bronchoscopy. It reduces the need for repeated airway manipulation, provides better oxygenation with comparable ventilation, maintains continuous airway control, and serves as a reliable conduit for bronchoscope insertion.