Advertisement

Anesthesiology pp 199-213 | Cite as

Anesthesia for Bronchoscopic Procedures

  • Mona Sarkiss
Chapter

Abstract

Bronchoscopic procedures whether diagnostic or therapeutic constitute a challenge to both the brochoscopist and the patient due to the anxiety and vigorous airway reflexes associated with airway instrumentation as well as the pathology affecting airway patency and/or ventilation. This chapter will first describe the common bronchoscopic procedures and the main preoperative evaluation pointers. This is followed by a detailed description of the spectrum of anesthesia techniques, from light sedation to general anesthesia, that can be used to facilitate bronchoscopic procedures. Additionally, a depiction of a variety of ventilation techniques and airway devices that are used for airway procedures is detailed. Complications associated with bronchoscopic airway procedures and their management is also discussed. Lastly, the design of a bronchoscopic suite where anesthesia support for bronchoscopic procedures can be performed safely is described.

Keywords

Interventional bronchoscopy Bronchoscopy suite Jet ventilation Rigid bronchoscopy Therapeutic bronchoscopy 

References

  1. 1.
    Becker HD. Bronchoscopy: the past, the present, and the future. Clin Chest Med. 2010;31(1):1–18, Table of Contents.CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax. 2001;56(Suppl 1):i1–21.Google Scholar
  3. 3.
    Ost DE, Ernst A, Lei X, Feller-Kopman D, Eapen GA, Kovitz KL, Herth FJ, Simoff M. Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration: results of the AQuIRE Bronchoscopy Registry. Chest. 2011;140(6):1557–66.CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Herth FJ, Eberhardt R, Krasnik M, Ernst A. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and positron emission tomography-normal mediastinum in patients with lung cancer. Chest. 2008;133(4):887–91.CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Sarkiss M, Kennedy M, Riedel B, Norman P, Morice R, Jimenez C, Eapen G. Anesthesia technique for endobronchial ultrasound-guided fine needle aspiration of mediastinal lymph node. J Cardiothorac Vasc Anesth. 2007;21(6):892–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Khan KA, Nardelli P, Jaeger A, O’Shea C, Cantillon-Murphy P, Kennedy MP. Navigational bronchoscopy for early lung cancer: a road to therapy. Adv Ther. 2016;33(4):580–96.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Conacher ID, Curran E. Local anaesthesia and sedation for rigid bronchoscopy for emergency relief of central airway obstruction. Anaesthesia. 2004;59(3):290–2.CrossRefPubMedGoogle Scholar
  8. 8.
    Perrin G, Colt HG, Martin C, Mak MA, Dumon JF, Gouin F. Safety of interventional rigid bronchoscopy using intravenous anesthesia and spontaneous assisted ventilation. A prospective study. Chest. 1992;102(5):1526–30.CrossRefPubMedGoogle Scholar
  9. 9.
    Ernst A, Silvestri GA, Johnstone D. Interventional pulmonary procedures: guidelines from the American College of Chest Physicians. Chest. 2003;123(5):1693–717.CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Ausseur A, Chalons N. [Anesthesia in interventional bronchoscopy]. Rev Mal Respir. 1999;16(4 Pt 2):679–83.Google Scholar
  11. 11.
    Wahidi MM, Jain P, Jantz M, Lee P, Mackensen GB, Barbour SY, Lamb C, Silvestri GA. American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients. Chest. 2011;140(5):1342–50.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Fox BD, Krylov Y, Leon P, Ben-Zvi I, Peled N, Shitrit D, Kramer MR. Benzodiazepine and opioid sedation attenuate the sympathetic response to fiberoptic bronchoscopy. Prophylactic labetalol gave no additional benefit. Results of a randomized double-blind placebo-controlled study. Respir Med. 2008;102(7):978–83.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Abdelmalak B, Makary L, Hoban J, Doyle DJ. Dexmedetomidine as sole sedative for awake intubation in management of the critical airway. J Clin Anesth. 2007;19(5):370–3.CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Clark G, Licker M, Younossian AB, Soccal PM, Frey JG, Rochat T, Diaper J, Bridevaux PO, Tschopp JM. Titrated sedation with propofol or midazolam for flexible bronchoscopy: a randomised trial. Eur Respir J. 2009;34(6):1277–83.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Bruhn J, Myles PS, Sneyd R, Struys MM. Depth of anaesthesia monitoring: what’s available, what’s validated and what’s next? Br J Anaesth. 2006;97(1):85–94.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Abdelmalak B, Ryckman JV, AlHaddad S, Sprung J. Respiratory arrest after successful neodymium:yttrium-aluminum-garnet laser treatment of subglottic tracheal stenosis. Anesth Analg. 2002;95(2):485–6, table of contents.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Hung WT, Liao SM, Su JM. Laryngeal mask airway in patients with tracheal stents who are undergoing non-airway related interventions: report of three cases. J Clin Anesth. 2004;16(3):214–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Kirsner KM, Sarkiss M, Brydges GJ. Treatment of tracheal and bronchial tumors and tracheal and bronchial stent placement. AANA J. 2010;78(5):413–9.PubMedGoogle Scholar
  19. 19.
    Ayers ML, Beamis JF Jr. Rigid bronchoscopy in the twenty-first century. Clin Chest Med. 2001;22(2):355–64.CrossRefPubMedGoogle Scholar
  20. 20.
    Wahidi MM, Herth FJ, Ernst A. State of the art: interventional pulmonology. Chest. 2007;131(1):261–74.CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Clouzeau B, Bui HN, Guilhon E, Grenouillet-Delacre M, Leger MS, Saghi T, Pillot J, Filloux B, Coz S, Boyer A, et al. Fiberoptic bronchoscopy under noninvasive ventilation and propofol target-controlled infusion in hypoxemic patients. Intensive Care Med. 2011;37:1969–75.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Ambrosino N, Guarracino F. Unusual applications of noninvasive ventilation. European Respiratory Journal. 2011;38(2):440–9.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Fernandez-Bustamante A, Ibanez V, Alfaro JJ, de Miguel E, German MJ, Mayo A, Jimeno A, Perez-Cerda F, Escribano PM. High-frequency jet ventilation in interventional bronchoscopy: factors with predictive value on high-frequency jet ventilation complications. J Clin Anesth. 2006;18(5):349–56.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Kraincuk P, Kepka A, Ihra G, Schabernig C, Aloy A. A new prototype of an electronic jet-ventilator and its humidification system. Crit Care. 1999;3(4):101–10.CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Vaitkeviciute IEJ. Con: Bronchial stenting and laser airway surgery should not take place outside the operating room. J Cardiothorac Vasc Anesth. 2005;19:121–2.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Amat B, Günther R, Carlos A, Antoni X, Antoni T. What is an interventional pulmonology unit in Europe? Clinical Pulmonary Medicine. 2010;17(1):42–6.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Perioperative MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Pulmonary MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations