Bronchoscopy in children with diffuse alveolar hemorrhage under general anesthesia with spontaneous respiration by face mask ventilation

Abstract

Purpose: To improve the management level of general anesthesia during bronchoscopy in the children with diffuse alveolar hemorrhage (DAH). Methods: A retrospective study was conducted in the children with DAH who had performed bronchoscopy under general anesthesia with spontaneous respiration by face mask ventilation initially from June 2021 to June 2022 in our hospital. Results: 1. Thirty-four children who had underwent 38 bronchoscopy procedures were included. 2. General anesthesia induction was performed by bolus of propofol intravenous in all the procedures. For maintaining anesthesia, 31 procedures (81.6%) received both propofol and remifentanil intravenously infusion and the rest 7 procedures (18.4%) received propofol intravenously infusion only. An intravenous bolus of ketamine or propofol was given as an anesthetic adjuvant in 21 procedures (55.3%). Thirty-five procedures (92.1%) were successfully completed under non-tracheal intubation ventilation, whereas the rest 3 procedures (7.9%) needed change to tracheal intubation ventilation. 3. Respiratory depression was found in 7 procedures (18.4%), laryngospasm was found in 2 procedure (2.6%) and bronchospasm was found in 17 procedures (44.7%). Sixteen procedures (42.1%) developed intraoperative hypoxemia. The incidence of intraoperative hypoxemia in the procedures at the active phage of disease was significantly higher compared to those at the remission phage of the disease (P<0.05). Sixteen procedures (42.1%) developed intraoperative hypercapnia. Two procedures (5.3%) were complicated by severe pulmonary hemorrhage. Conclusions: General anesthesia with spontaneous respiration by face mask ventilation is feasible and relatively safe for the children with DAH undergoing bronchoscopy, whereas the anesthetic protocol still needs to be improved.