Medication
Short acting or ultra-short acting anesthetics in order to avoid post procedure depression of respiratory function e.g., Propofol, Remifentanil
Anesthesia technique
TIVA in most cases. Inhalation anesthesia in patients with reactive airway
Ventilation
High FiO2 to maintain adequate saturation, expect and manage Hypercabnia, FiO2 reduction during LASER and cautery in the airway
Monitoring
Standard. BIS monitor for the depth of TIVA. Consider invasive or non-invasive hemodynamic monitoring for rigid bronchoscopy cases
Airway devices
LMA, rigid bronchoscope and less frequently ETT
Recovery
30–45 min with the use of ultra-short acting anesthetic medications
Frequent suctioning of airway secretion, blood and saline washes can alter the concentration of inhalation anesthetic dose delivered to the patient.
Frequent changes in airway devices used during a procedure, e.g., LMA, rigid bronchoscopy, endotracheal tube (ETT), can lead to interruption in the delivery of inhalation anesthetic and varying depth of anesthesia while the airway device is being exchanged.
Multiple insertion and removal of the bronchoscope through an airway device during a procedure can lead to leak of the inhalation agent to the environment of the bronchoscopy suite and exposure of the healthcare worker to anesthetic agents.
However, it is important to note that in the event of bronchospasm during bronchoscopic procedures, inhalation agents are considered a potent bronchodilator and the benefits of its use might outweigh the risks.
The authors preferred airway device for bronchoscopic procedures is the LMA and the rigid bronchoscopy.
The LMA allows for a complete inspection of the central airway as compared to the ETT. An appropriately placed ETT obscures the upper airway down to the mid-trachea.
LMA insertion avoid trauma to upper and mid tracheal lesions that can occur with ETT insertion.
Endotracheal intubation can be performed easily through the LMA if needed
The large barrel of the rigid bronchoscope allows the bronchoscopist to use a wider variety of instrument to manage the airway pathology.
The rigid bronchoscope can be used to manage complications that are anticipated during bronchoscopic procedures e.g., tamponade tracheal and bronchial bleeding and coring of tumors obstruction the central airways.Related posts:
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