Spontaneous Breathing for Panendoscopy? Retrospective Cohort and Results of a French Practice Survey

Abstract

Objective: Avoiding tracheal intubation by using general anesthesia with spontaneous breathing (GASB) is attractive for upper airway panendoscopy. The aim of this study was to estimate the incidence of adverse events during panendoscopy under GASB and to assess the practices of French anesthesiologists.

Study design: Two-phase study: monocentric retrospective study and national survey.

Setting: University hospital center.

Methods: Patients who underwent a panendoscopy under GASB at the University Hospital of Angers between January 1 and December 31, 2014, were reviewed. Failure of GASB was defined as an episode of hypoxemia (SpO₂ ≤88%) or the need for face mask ventilation with or without tracheal intubation. Then, we sent an electronic survey to all members of the French Society of Anaesthesia and Intensive Care.

Results: Among the 95 included patients, 22 (23%) experienced a failure of GASB: 3 tolerated hypoxemia, 15 had face mask ventilation episodes, and 4 were intubated. Three factors were associated with failure: obesity (odds ratio, 11.94; 95% CI, 3.20-44.64), history of difficult intubation defined as a Cormack score ≥3 (odds ratio, 6.20; 95% CI, 1.51-25.41), and laryngeal tumor (odds ratio, 2.81; 95% CI, 1.04-7.56). Among the 3930 members of the French Society of Anaesthesia and Intensive Care in 2018, 662 (16.8%) responded to the survey. The 2 preferred techniques to perform panendoscopy were intubation (62%) and intravenous sedation with spontaneous breathing (37%).

Conclusion: Although general anesthesia with orotracheal intubation remains the preferred technique for panendoscopy in France, GASB is an attractive alternative with a low failure rate. Risk factors for failure are obesity, history of difficult intubation, and laryngeal tumor.

Keywords: general anesthesia; national survey; otorhinolaryngologic surgical procedure; panendoscopy; spontaneous breathing.

Figure 1.

Flowchart of patients. SB, spontaneous breathing.

Figure 2.

Disadvantages and advantages of the spontaneous breathing panendoscopy procedure according to ORL or non-ORL anesthesiologist groups. ORL group defined by an ORL activity of at least 50%. ORL, otorhinolaryngologist; OTI, orotracheal intubation; PONV, postoperative nausea and vomiting. *P = .038.

Figure 3.

Justification for not using the spontaneous breathing procedure according to whether respondents were in the ORL or non-ORL group. ORL group defined by an ORL activity of at least 50%. ORL, otorhinolaryngologist. *P = .015.