Abstract
Purpose of Review
To highlight the interaction between the emerging and constantly evolving field of interventional pulmonology and the practice of anesthesiology.
Recent Findings
The current field of interventional pulmonology encompasses diagnostic bronchoscopic procedures designed for both diagnosis and staging of lung cancer, diagnosis of the etiology of mediastinal lymphadenopathy as well as lung nodules, and therapeutic bronchoscopic procedures performed through the rigid bronchoscope. Modifications of the everyday anesthesia techniques used in the operating room are necessary to adapt to the type of patients undergoing the procedures and sharing the airway with the interventional pulmonologist. The choice of anesthesia medications, airway devices, and ventilation strategy can impact the success and the safety of the procedure.
Summary
This review will discuss the available literature and highlight the common current practices used in large academic centers to manage procedures performed in the central airway, from the proximal end of the trachea to the furthest bronchoscopically accessible bronchi, and on peripheral lung nodules.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Colt HG, Williamson JP. Training in interventional pulmonology: what we have learned and a way forward. Respirology. 2020;25(9):997–1007.
Lee HJ, Corbetta L. Training in interventional pulmonology: the European and US perspective. Eur Respir Rev. 2021;30:200025. This article descibes the training programs in interventional pulmonology in both Europe and the US.
Criner GJ, Eberhardt R, Fernandez-Bussy S, Gompelmann D, Maldonado F, Patel N, et al. Interventional bronchoscopy. Am J Respir Crit Care Med. 2020;202(1):29–50. This is a great review of the scope of procedures performed in interventional bronchoscopy.
Kalsi HS, Thakrar R, Gosling AF, Shaefi S, Navani N. Interventional pulmonology: a brave new world. Thorac Surg Clin. 2020;30(3):321–38. This article discusses the current and emerging diagnostic and therapeutic interventional pulmonolgy procedures for the lower airway and lung.
Mondoni M, Radovanovic D, Sotgiu G, Di Marco F, Carlucci P, Centanni S, et al. Interventional pulmonology techniques in elderly patients with comorbidities. Eur J Intern Med. 2019;59:14–20.
Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American Society of Anesthesiologists Practice Guidelines for management of the difficult airway*. Anesthesiology. 2022;136(1):31–81.
Schmutz A, Durk T, Idzko M, Koehler T, Kalbhenn J, Loop T. Feasibility of a supraglottic airway device for transbronchial lung cryobiopsy-a retrospective analysis. J Cardiothorac Vasc Anesth. 2017;31(4):1343–7. This article describes the use of supraglottic airway devices in interventional pulmonolgy procedures.
Behrens KM, Galgon RE. Supraglottic airway versus endotracheal tube during interventional pulmonary procedures - a retrospective study. BMC Anesthesiol. 2019;19(1):196.
Batra H, Yarmus L. Indications and complications of rigid bronchoscopy. Expert Rev Respir Med. 2018;12(6):509–20.
Diaz-Mendoza J, Peralta AR, Debiane L, Simoff MJ. Rigid bronchoscopy. Semin Respir Crit Care Med. 2018;39(6):674–84.
Li JJ, Li N, Ma WJ, Bao MX, Chen ZY, Ding ZN. Safety application of muscle relaxants and the traditional low-frequency ventilation during the flexible or rigid bronchoscopy in patients with central airway obstruction: a retrospective observational study. BMC Anesthesiol. 2021;21(1):106. This article describes the use of muscle relaxant and low frequancy jet ventilation during rigid bronchoscopic procedures.
Okamoto S, Somiya N, Saito AM, Kada A, Oki M, Saka H, et al. A prospective, randomized trial comparing respiratory status during anesthesia for airway stenting: spontaneous respiration versus controlled ventilation with muscle relaxants. Anesth Analg. 2020;131(3):893–900.
Putz L, Mayne A, Dincq AS. Jet ventilation during rigid bronchoscopy in adults: a focused review. Biomed Res Int. 2016;2016:4234861. A good review of the use of jet ventilation in rigid bronchoscopy procedures.
Mahajan AK, Patel PP, Garg R, Manley C, Ibrahim O, Mehta AC. Safety of laser and thermal therapy during rigid bronchoscopy using manual hand jet ventilation. Surg Technol Int. 2021;39:103–6.
Ishiwata T, Gregor A, Inage T, Yasufuku K. Advances in interventional diagnostic bronchoscopy for peripheral pulmonary lesions. Expert Rev Respir Med. 2019;13(9):885–97.
Casal RF, Sarkiss M, Jones AK, Stewart J, Tam A, Grosu HB, et al. Cone beam computed tomography-guided thin/ultrathin bronchoscopy for diagnosis of peripheral lung nodules: a prospective pilot study. J Thorac Dis. 2018;10(12):6950–9.
Sagar AS, Sabath BF, Eapen GA, Song J, Marcoux M, Sarkiss M, et al. Incidence and location of atelectasis developed during bronchoscopy under general anesthesia: the I-LOCATE Trial. Chest. 2020;158(6):2658–66. First article to descibe atelectasis during bonchoscopy and its effect on the yield of lung nodule biopsy.
Pritchett MA, Lau K, Skibo S, Phillips KA, Bhadra K. Anesthesia considerations to reduce motion and atelectasis during advanced guided bronchoscopy. BMC Pulm Med. 2021;21(1):240. This article decribes the current recommendations for ventilation techniques modifications needed to reduce atelectasis and increase lung nodule biopsy yield.
Abdelmalak BB, Gildea TR, Doyle DJ, Mehta AC. A blueprint for success: a multidisciplinary approach to clinical operations within a bronchoscopy suite. Chest. 2021.
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Mona Sarkiss declares that she does not have conflict of interest.
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PubMed search for anesthesia and interventional bronchoscopy.
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Sarkiss, M., Eapen, G.A. Airway Management for Central Airway and Transbronchial Lung Procedures. Curr Anesthesiol Rep 12, 390–397 (2022). https://doi.org/10.1007/s40140-022-00535-z
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DOI: https://doi.org/10.1007/s40140-022-00535-z