Anesthesia for Advanced Bronchoscopic Procedures: State-of-the-Art Review.
The bronchoscopic procedures have seen a remarkable increase in both numbers and complexity. Although many anesthesia providers have kept pace with the challenge, the practice is varied and frequently suboptimal. Shared airway during bronchoscopy poses unique challenges. The available reviews have tried to address this lacuna; however, these have frequently dealt with the technical aspects of bronchoscopy than anesthetic challenges. The present review provides evidence-based management insights into anesthesia for bronchoscopy-both flexible and rigid. A systematic approach toward pre-procedural evaluation and risk stratification is presented. The possible anatomical and physiological factors that can influence the outcomes are discussed. Pharmacological principles guiding sedation levels and appropriate selection of sedatives form the crux of safe anesthetic management. The newer and safer drugs that can have potential role in anesthesia for bronchoscopy in the near future are discussed. Ventilatory strategies during bronchoscopy for prevention of hypoxia and hypercarbia are emphasized.
Department of Anesthesiology and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA, BasavanaGouda.Goudra@uphs.upenn.edu.
Basavana G
BG
Goudra
Preet Mohinder
PM
Singh
Anuradha
A
Borle
Nahla
N
Farid
Kassem
K
Harris
D000758:Anesthesia / Q000379:methods*; D000768:Anesthesia, General; D000779:Anesthetics, Local; D001569:Benzodiazepines; D001999:Bronchoscopy / Q000379:methods*; D020927:Dexmedetomidine; D006801:Humans; D006993:Hypnotics and Sedatives; D016343:Monitoring, Intraoperative; D010880:Piperidines; D011300:Preoperative Care; D015742:Propofol; D000077208:Remifentanil; D012121:Respiration, Artificial; D018570:Risk Assessment
D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D010880:Piperidines; D001569:Benzodiazepines; D020927:Dexmedetomidine; C522201:remimazolam; D000077208:Remifentanil; D015742:Propofol