Anesthesia for interventional pulmonology procedures: a review of advanced diagnostic and therapeutic bronchoscopy

  • Andres de Lima
  • Fayez Kheir
  • Adnan Majid
  • John Pawlowski
Review Article/Brief Review

Abstract

Purpose

Interventional pulmonology is a growing subspecialty of pulmonary medicine with flexible and rigid bronchoscopies increasingly used by interventional pulmonologists for advanced diagnostic and therapeutic purposes. This review discusses different technical aspects of anesthesia for interventional pulmonary procedures with an emphasis placed on pharmacologic combinations, airway management, ventilation techniques, and common complications.

Source

Relevant medical literature was identified by searching the PubMed and Google Scholar databases for publications on different anesthesia topics applicable to interventional pulmonary procedures. Cited literature included case reports, original research articles, review articles, meta-analyses, guidelines, and official society statements.

Principal findings

Interventional pulmonology is a rapidly growing area of medicine. Anesthesiologists need to be familiar with different considerations required for every procedure, particularly as airway access is a shared responsibility with pulmonologists. Depending on the individual case characteristics, a different selection of airway method, ventilation mode, and pharmacologic combination may be required. Most commonly, airways are managed with supraglottic devices or endotracheal tubes. Nevertheless, patients with central airway obstruction or tracheal stenosis may require rigid bronchoscopy and jet ventilation. Although anesthetic approaches may vary depending on factors such as the length, complexity, and acuity of the procedure, the majority of patients are anesthetized using a total intravenous anesthetic technique.

Conclusions

It is fundamental for the anesthesia provider to be updated on interventional pulmonology procedures in this rapidly growing area of medicine.

Anesthésie pour procédures interventionnelles en pneumologie : revue des implications de la bronchoscopie avancée à buts diagnostique et thérapeutique

Résumé

Objectif

La pneumologie interventionnelle est une sous-spécialité de la pneumologie en progression grâce à l’utilisation croissante des bronchoscopes souples et rigides par les pneumologues interventionnels à des fins diagnostiques et thérapeutiques avancées. Cette analyse aborde les différents aspects techniques de l’anesthésie pour les procédures interventionnelles en pneumologie en insistant sur les combinaisons pharmacologiques, la gestion des voies respiratoires, les techniques de ventilation et les complications fréquentes.

Source

La littérature médicale pertinente a été identifiée par une recherche des publications sur différents sujets d’anesthésie applicables aux procédures interventionnelles en pneumologie dans les bases de données PubMed et Google Scholar. Les publications citées ont inclus des rapports de cas, des articles de recherche originale, des articles de synthèse, des méta-analyses, des lignes directrices et les déclarations officielles de sociétés savantes.

Constatations principales

La pneumologie interventionnelle est une branche de la médecine qui se développe rapidement. Les anesthésiologistes ont besoin de se familiariser avec les différents problèmes soulevés par chaque procédure, en particulier dans la mesure où la responsabilité de l’accès aux voies respiratoires est partagée avec les pneumologues. La méthode de gestion des voies aériennes, le mode de ventilation et la combinaison pharmacologique pourront être choisis en fonction des caractéristiques de chaque cas particulier. Le plus souvent, les voies respiratoires sont gérées avec des dispositifs supraglottiques ou des tubes endotrachéaux. Néanmoins, les patients présentant une obstruction centrale des voies respiratoires ou une sténose de la trachée peuvent nécessiter le recours à un bronchoscope rigide et à une jet-ventilation. Bien que la démarche anesthésique puisse varier en fonction de facteurs tels que la durée, la complexité et la gravité de la procédure, la majorité des patients sont anesthésiés en employant une technique intraveineuse totale.

Conclusions

Il est essentiel que le professionnel assurant l’anesthésie connaisse les plus récentes procédures interventionnelles en pneumologie dans ce domaine rapidement croissant de la médecine.

Notes

Conflicts of interest

Adnan Majid: Paid consultant for PneumRx, Inc., paid consultant for Olympus Corporations of the Americas, paid consultant for Broncus Medical Inc., and paid consultant for Boston Scientific Corp.

Editorial responsibility

This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.

Author contributions

Andrés de Lima, Fayez Kheir, Adnan Majid, and John Pawlowski contributed substantially to all aspects of this manuscript, including conception and design; acquisition, analysis, and interpretation of data; and drafting the article.

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Copyright information

© Canadian Anesthesiologists' Society 2018

Authors and Affiliations

  • Andres de Lima
    • 1
  • Fayez Kheir
    • 1
    • 2
  • Adnan Majid
    • 1
  • John Pawlowski
    • 3
  1. 1.Division of Thoracic Surgery and Interventional PulmonologyBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonUSA
  2. 2.Division of Pulmonary Diseases, Critical Care and Environmental MedicineTulane University Health Sciences CenterNew OrleansUSA
  3. 3.Department of Anesthesia, Division of Thoracic AnesthesiaBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonUSA

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