Application of Low-dose Muscle Relaxants in Bronchoscopic Interventional Procedures

Observe the degree of glottic opening (grade I: glottis opens well; grade II: glottis opens >⅔, mild laryngospasm; grade III: glottis opens ⅓-⅔, moderate laryngospasm; grade IV: glottis opens ≤⅓ or is completely closed, severe laryngospasm).Grades III and IV were defined as laryngospasm.

The patient's sore throat was evaluated using the visual analogue scale. A 10-cm movable ruler with 10 marks was used, with the two ends marked at 0 and 10 respectively. The patient was asked to mark the corresponding position on the ruler that represented their degree of pain. 0 represented no pain, and 10 represented extremely painful.

After the surgery, inquire whether the patient has any difficulty in swallowing.

The number of patients with SpO₂ < 92% during mask ventilation in the induction period / total number of patients in the group

Grade 1: Slight movement that does not interfere with the procedure.

Grade 2: Pronounced movement that interferes with the procedure.

Grade 3: Thrashing or vigorous movement that significantly interferes with the procedure.

Mild: No difficult ventilation but with stiffness of the limbs or abdominal wall.

Moderate: Difficult ventilation accompanied by noticeable limb stiffness or abdominal wall rigidity.

Severe: Inability to ventilate with significant limb stiffness or abdominal wall rigidity.

Grade A represented the presence of an end-tidal carbon dioxide (PETCO₂) waveform plateau; Grade B, the absence of a plateau but with a PETCO₂ value ≥ 10 mmHg; Grade C, the absence of a plateau and a PETCO₂ value < 10 mmHg; and Grade D, the absence of a detectable PETCO₂ waveform. Grades C and D were classified as difficult facemask ventilation.

Grade 0: no choking cough response; grade 1: single mild choking cough response; grade 2: multiple mild choking cough responses(<=5s); grade 3: severe choking cough response(>5s).

After the surgery, ask the patient if they are experiencing nausea.

Record the number of times the laryngeal mask is inserted when it is placed.

After the surgery, ask the patient if they feel like vomiting.

The difficulty level of inserting the laryngeal mask can be determined by observing the mouth opening during insertion, the resistance encountered during insertion, the presence or absence of choking and body movement, and the time taken for insertion. It is classified into four levels: simple, slightly difficult, difficult, and failed.

After the patient regains consciousness, ask the patient if they have any bloating in the stomach.

After the patient regains consciousness, the presence of hoarseness in the patient is determined through communication with the patient.

The time required for laryngeal mask airway (LMA) insertion was measured from the initiation of the insertion attempt until correct placement was confirmed by the appearance of a normal end-tidal carbon dioxide (ETCO₂) waveform on capnography.

Blood Pressure: The lateral pressure exerted by blood on the walls of blood vessels when it flows within them. Systolic blood pressure (SBP): The highest pressure in the arteries during the contraction of the heart (normal range: 90 - 120 mmHg). Diastolic blood pressure (DBP): The lowest pressure in the arteries during the relaxation of the heart (normal range: 60 - 80 mmHg).

Heart Rate: Number of heartbeats per minute (unit: beats per minute, bpm). . Normal resting heart rate: 60-100 beats per minute for adults.

(For athletes or those who engage in long-term exercise, it can be as low as 40-50 beats per minute.)

Blood oxygen saturation (SpO2): The percentage of oxyhemoglobin (HbO2) in the blood relative to the total hemoglobin (Hb), reflecting the oxygenation status of the body. . Normal range: For healthy adults at rest, it is 95% - 100%. Anything below 90% indicates hypoxemia.

BIS is a method that analyzes the linear (frequency, power) and non-linear (phase, harmonic) components of electroencephalogram (EEG) data, converting them into quantitative indicators ranging from 0 to 100, which is used to assess the inhibitory or excitatory state of the cerebral cortex.

Value range: 0 indicates no brainwave activity, and 100 represents a fully awake state.

Core function: Primarily used for monitoring the depth of anesthesia, the level of sedation, and the state of consciousness, reducing the risk of intraoperative awareness.

Airway peak pressure is a very important parameter in mechanical ventilation, referring to the highest pressure value reached within one inhalation phase in the breathing circuit. The normal range is typically between 15 - 30 cmH2O. However, this varies depending on factors such as the patient's pathophysiological condition, ventilation mode, tidal volume, flow rate, and PEEP setting.

Airway plateau pressure is a key parameter for evaluating the pressure that alveoli can withstand in mechanical ventilation, reflecting the pressure (plus the set PEEP) required to overcome the elastic resistance (compliance) of the lungs and chest cavity. It can more directly reflect the degree of alveolar expansion at the end of inspiration and predict the risk of ventilator-associated lung injury (such as pressure injury, volume injury). The generally accepted safe upper limit is ≤ 30 cmH₂O (including PEEP).

End-tidal carbon dioxide (EtCO₂) monitoring is a non-invasive, real-time, and continuous important technique. By measuring the partial pressure (usually expressed in mmHg or kPa) or concentration (%) of carbon dioxide in the exhaled gas of the patient, it reflects the ventilation function, metabolic status, and circulatory status. It is an indispensable monitoring method in anesthesia, intensive care, emergency rescue (especially cardiopulmonary resuscitation). Normal value: Adult: 35 - 45 mmHg (approximately 4.7 - 6.0 kPa).

The dosages of the following drugs were recorded throughout the perioperative period: lidocaine, remimazolam, remifentanil, rocuronium, propofol, ephedrine, norepinephrine, atropine, esmolol, ebrantil, dyphylline, and dexamethasone.We calculated the total consumption of remimazolam and remifentanil, as well as the average consumption of remimazolam (total remimazolam consumption / duration of surgery / body weight) and the average consumption of remifentanil (total remifentanil consumption / duration of surgery / body weight).

The operating physician rated their satisfaction with the procedure on a scale from 1 to 10. The evaluation was based on procedural convenience, oxygenation stability (specifically, whether hypoxemia necessitated interruption of the procedure), and the overall smoothness of the workflow.

Anesthesiologist satisfaction with the procedure was rated on a scale from 1 to 10. The evaluation was based on the difficulty of airway management (particularly the frequency of interventions required to maintain adequate ventilation), the efficacy of oxygenation maintenance, and the incidence of adverse events.

Patients rated their satisfaction with the procedure on a scale from 1 to 10. The rating was based on procedural comfort, the postoperative recovery experience, and their subjective perception of the sedation process.

The incidence of systolic blood pressure less than 80% of baseline.

The incidence of systolic blood pressure greater than 160 mmHg, exceeding 120% of baseline, or diastolic blood pressure greater than 100 mmHg.

The incidence of heart rate less than 50 beats per minute (bpm).

The incidence of heart rate greater than 100 beats per minute (bpm).

The incidence of cough grades 2 and 3.

The incidence of body movement grades 2 and 3.

The frequency of the following airway rescue interventions was recorded: increasing the oxygen flow rate, administering manual ventilation, administering an intravenous bolus of diprophylline (0.25 g), and administering intravenous dexamethasone (5 mg).

The incidence of peak airway pressure greater than 30 cmH₂O.

The number of patients with SpO₂ < 92% during bronchoscope insertion divided by the total number of patients in the group

The number of patients who reported shortness of breath after regaining consciousness divided by the total number of patients in the group

from insertion of the bronchoscope by the pulmonologist to completion of the procedure.

from the start of anesthesia induction until the patient met the discharge criteria.

from cessation of anesthetic infusion until the patient regained consciousness.

from cessation of anesthetic infusion until the patient met the discharge criteria.