Xiaoping Wang, Department of Respiratory Medicine, Shandong Chest Hospital Introduction In Europe and North America, general anesthesia bronchoscopic interventions are performed in many cases by rigid bronchoscopy combined with open ventilation techniques, because in comparison, bronchoscopic interventions under local anesthesia conditions are more risky, difficult to operate in many lesions, and some procedures are difficult to complete. At present, in China, bronchoscopic interventions let most of them be performed by local anesthesia because of the low popularity of general anesthesia respiratory endoscopy techniques. In fact, general anesthesia techniques are not difficult, and in this issue, let’s take a look at the bronchoscopy pathway. The basic problem that needs to be solved for the implementation of endotracheal interventions under general anesthesia is the ventilation of the patient and the sharing of the “airway” with the anesthesiologist, which increases the risk of anesthesia to some extent. Although the best route is rigid bronchoscopy under open ventilation, tracheal intubation and laryngeal mask techniques can replace rigid bronchoscopy in most cases, especially in patients with unilateral lungs, where rigid open ventilation is often difficult to ensure effective ventilation and the procedure can be completed successfully with a transtracheal intubation or laryngeal mask. In this issue, let’s take a general look at the respective characteristics of rigid tracheoscope, tracheal intubation, and laryngeal mask: rigidoscope: lesions of the central airway, requiring the cooperation of open ventilation techniques, with perfect related surgical instruments and equipment. Laryngeal mask: applicable to all subglottic lesions and is an effective solution for high subglottic tracheal lesions. Tracheal intubation: for lesions below 5 cm below the subglottis, with a safe and reliable guarantee of mechanical ventilation. Laryngeal mask The laryngeal mask is suitable for all lesions in the airway, especially for high subglottic tracheal lesions. It can also be considered that the laryngeal mask can be preferred in cases where rigid tracheoscopy or tracheal intubation methods are not competent, such as lesions at the upper end of the trachea. The laryngeal mask provides better confinement compared to rigid scopes. In comparison with tracheal intubation, when the airway is severely narrowed and the airway pressure is high, the laryngeal mask is not as airtight as the tracheal intubation and is prone to air leakage around the vocal cords. Furthermore, the correct positioning of the mask is also crucial. (See the figure below.) For patients with a small vocal fold gap due to vocal fold edema or abnormal pharyngeal decompensation due to mandibular surgery, it is easy to cause poor ventilation or displacement of the mask, which is not the best choice. In addition, our clinical experience generally selects a laryngeal mask model between 3 and 4 for patients, where the tracheoscope does not have resistance to passing through the mask, allowing for better tracheoscopic intervention. The correct position of the laryngeal mask for tracheoscopic view: rigid tracheoscopic interventions under general anesthesia are safe and effective, but the “laryngeal mask and tracheal intubation” is easier to learn and easier to promote than the “rigid tracheoscopic” approach. In most cases, treatment with a “rigid scope” can be done well with a “laryngeal mask or tracheal intubation”. However, the advantage of a rigid scope is that the diameter is thicker and it is easier to reach the lesion, so it is more convenient and better able to handle unexpected situations. Especially when the rigid scope can be used in combination with a soft scope, it can provide a better understanding of the distal tracheobronchus. At present, we also use a combination of rigid and flexible scopes, with rigid scopes as a channel to ensure ventilation, and flexible scopes to pass through the narrow section of the trachea to perform a comprehensive examination of the endotracheobronchial lesions and judge the effect of treatment, especially for the bronchial parts that cannot be reached by rigid bronchoscopes, flexible scopes are more useful for examination.