The Safety and Efficacy of General Anesthesia Bronchoscopy in Patients With Metastatic Brain Lesions

Abstract

Background: Lung cancer is the leading cause of cancer-related death in the United States and has a high propensity to metastasize to the brain. According to multiple studies, primary lung malignancy is the leading cause of brain metastasis. In many cases, patients with suspected lung cancer will present with brain metastasis and require bronchoscopy for diagnostic and therapeutic purposes, specifically, endobronchial ultrasound transbronchial needle aspiration, which can both diagnose and stage lung cancer. There is a concern that general anesthesia and bronchoscopic procedures can increase intracranial pressures and lead to neurological complications. Methods: We conducted a retrospective study evaluating the safety of performing bronchoscopy under general anesthesia in patients with known space-occupying brain lesions at Keck Hospital of the University of Southern California between 2015 and 2018. Results: Overall, 10% of patients who underwent bronchoscopy had brain lesions at the time of the procedure, similar to previous studies, which showed rates of 10% to 20%. Overall complication rate with general anesthesia and bronchoscopy was 21% in our patients with brain lesions; however, only 3.5% of patients experienced serious adverse events, including respiratory failure or neurological deterioration requiring intensive care unit admission and intervention. There was no difference in complications among those with brain metastasis and those without who underwent bronchoscopy. Conclusion: These results confirm that the rate of serious complications in patients with space-occupying brain lesions who undergo bronchoscopy with general anesthesia is similar to that in patients without brain lesions, indicating that bronchoscopy can be performed safely in this patient population.