Anesthesia for interventional pulmonology

Semmelmann, Axel; Loop, Torsten

doi:10.1097/aco.0000000000001079

Cited by 6 publications

(4 citation statements)

References 43 publications

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“…Premedication with atropine and glycopyrrolate, which were frequently used in the past, are no longer preferred (17). Additionally, for a possible airway collapse during anesthesia induction, the pulmonologist should be present and the rigid bronchoscope should be placed quickly (5,16). In this study, premedication was not administered before induction of anesthesia, and none of the patients required emergency airway management due to airway collapse.…”

Section: Discussionmentioning

confidence: 96%

“…Premedication before the procedure can be done if the general condition of the patients is suitable. However, it should be done carefully considering the serious problems that respiratory depression can cause in these patients who already have limited pulmonary reserves (15,16). Premedication with atropine and glycopyrrolate, which were frequently used in the past, are no longer preferred (17).…”

Section: Discussionmentioning

confidence: 99%

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Anesthesia management and challenges during interventional pulmonology procedures for central airway obstructions

Ulger

Sazak

Şener

et al. 2022

Anatolian Current Medical Journal

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Aim: Central airway obstructions (CAO) are one of the main reasons for morbidity and mortality, often originate in the lungs, and are generally unresectable. Interventional airway procedure is a preferred method in these cases. This study aimed to analyze anesthesia management in patients undergoing interventional procedures for CAO. We aimed to highlight the problem and solutions that may be encountered in such cases. Material and Method: The data of 49 patients who had interventional airway procedure were analyzed retrospectively. Patients’ demographic data, type of interventional procedures, localization of the lesion, and duration of the procedure were analyzed. Vital parameters and arterial blood gases (ABG) levels had been recorded before anesthesia induction (T1), after rigid bronchoscope insertion (T2), 20th-minute of the procedure (T3), after extubation (T4), and in the postoperative care unit (T5). Results: The mean age was 57.90±11.99 years. The mean duration of the procedure was 34.75±15.62 minutes. The majority of the patients had American Society of Anesthesiologists (ASA) III-IV physical status. CAOs were mostly found in the main bronchus. Tumors debulking, biopsy, mechanical dilatation, argon plasma coagulation, and mechanical tumor resection were the most performed procedures. Stent insertion was performed in 3 (6.1%) patients. Two patients (4.1%) had bleeding, 3 (6.1%) patients had desaturation, and 1 (2.1%) patient had atrial fibrillation. Conclusion: Interventional airway procedures are frequently used for high risk patients with CAO and comorbidities. Detailed preoperative evaluation, periprocedural teamwork, and close hemodynamic and ABG follow-up are keys to success.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Anesthesia management and challenges during interventional pulmonology procedures for central airway obstructions

Ulger

Sazak

Şener

et al. 2022

Anatolian Current Medical Journal

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“…However, there was a shortage of professional anesthesiologists and cytopathologists in many hospitals. The perfect anesthetic staff provides patient comfort and patient safety, while allowing the interventional pulmonologists complete access to the airways and subsequent procedures 21 . Some routine diagnostic bronchoscopy procedures (such as forceps biopsy, brushing, bronchoalveolar lavage, et al) can be performed under topical anesthesia or minimal/moderate sedation.…”

Section: Discussionmentioning

confidence: 99%

Application of bronchoscopy in the diagnosis and treatment of peripheral pulmonary lesions in China: a national cross-sectional study

Huang¹,

Wu²,

Tian³

et al. 2023

J. Cancer

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Background: Bronchoscopy has gradually become valuable armamentarium in evaluating and applying endoscopic therapy to peripheral pulmonary lesions (PPLs) around the world. We aimed to make a comprehensive understanding of the application of bronchoscopy in the diagnosis and treatment of PPLs in China. Methods: A cross-sectional survey was carried out in China between January 2022 and March 2022. The survey was in the form of an online questionnaire which was filled in with real-time data by the respondents. Results: A total of 347 doctors from 284 tertiary hospitals (81.8%) and 63 secondary general hospitals (18.2%) were included in the data analysis. More than half of the surveyed doctors (55.0%) had independently performed respiratory endoscopy for 5-15 years. Higher proportions of hospitals with a fixed nursing team, anesthesiologists and rapid on-site evaluation (ROSE) during bronchoscopic procedures were performed in tertiary hospitals than those in secondary general hospitals (P<0.001 each). There were 316 hospitals (91.7%) eligible for performing biopsies of PPLs less than 30mm, while more than 300 PPLs biopsies were performed in only 78 hospitals (24.7%) per year. Radial probe endobronchial ultrasound (r-EBUS) (50.3%) was the commonest type of technique used in the guidance of a bronchoscope to PPLs, followed by navigational bronchoscopy (30.3%) and cone beam CT (CBCT) (17.0%). Although two thirds of the surveyed hospitals had at least one bronchoscopic guidance devices, the actual utilization of these devices was not high due to high capital costs and absence of training. To note, more diagnostic procedures and allocated devices were concentrated in the southeast region and coastal cities. Furthermore, therapeutic bronchoscopic interventions for peripheral lung cancer and/or high-risk PPLs could be performed in 124 (35.7%) of the 347 involved hospitals. Conclusions: Bronchoscopy for the diagnosis of PPLs has been carried out in most hospitals in China and yields in different hospitals and regions varied greatly. To date, only a few hospitals in China can develop therapeutic bronchoscopy for PPLs.

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“…Guidelines from both the American College of Chest Physicians and British Thoracic Society recommend using topical anesthesia, analgesia, and sedation in all patients undergoing FB when there is no contraindication ( Wahidi et al, 2011 ; Du Rand et al, 2013 ). However, anodynia fiberoptic bronchoscopy represents a challenge for anesthesiologists because they must share the same airway with the endoscopist ( Semmelmann and Loop, 2022 ). In addition, the interactions and synergism between sedatives and opioids can significantly increase respiratory depression ( Finlay and Leslie, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Remimazolam Tosilate Versus Dexmedetomidine in Outpatients Undergoing Flexible Bronchoscopy: A Prospective, Randomized, Blind, Non-Inferiority Trial

Chen

Xin

et al. 2022

Front. Pharmacol.

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Purpose: This study aimed to compare the efficacy and safety of remimazolam tosilate-remifentanil (RT-RF) vs dexmedetomidine-remifentanil (Dex-RF) for outpatients undergoing fiberoptic bronchoscopy (FB).Patients and methods: We conducted a double-blind, randomized, prospective study involving a total of 146 outpatients undergoing FB divided into two groups. The RT-RF (RR) group (n = 73) received an initial dose of 12 mg/kg/h of RT for 10 min followed by a maintenance dose of 1–2 mg/kg/h, while the Dex-RF (DR) group (n = 73) received an initial dose of 0.5 μg/kg of Dex for 10 min followed by a maintenance dose of 0.2–0.7 μg/kg/h. All outpatients also received 0.05–0.2 μg/kg/min RF to maintain the Modified Observer’s Assessment of Alertness and Sedation (MOAA/S) scale <3. The primary outcome was rate of successful FB completed. Secondary outcomes were time metrics, hemodynamics, intubating conditions, oxygen saturation, coughing severity, number of remedies, total dose of fentanyl, RF, RT, and Dex, incidence of dreaming, patient and bronchoscopist satisfaction, willingness to repeat bronchoscopy, and adverse events.Results: The FB successful completion rate was 94.52% (95% CI: 89.20–99.90) in the RR group and 91.78% (95% CI: 85.30–98.20) in the DR group. Compared with patients in the DR group, the onset time, time to fully alert, and hospital discharge were all significantly shorter in the RR group (p < 0.01), and hemodynamics were more stable in the RR group. Intubating conditions, clinically acceptable intubating conditions, lowest oxygen saturation, coughing severity, consumption of fentanyl and RF, number of remedies, and patient and bronchoscopist satisfaction were similar between the groups (p > 0.05), as were demographic characteristics, incidence of dreaming, willingness to repeat bronchoscopy, and adverse events (p > 0.05).Conclusion: RT-RF has non-inferior efficacy, better time metrics and hemodynamic stability for outpatients undergoing FB than Dex-RF.Systematic Review Registration: [http://www.chictr.org.cn/showproj.aspx?proj=66673], identifier [ChiCTR2000041524].

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Anesthesia for interventional pulmonology

Cited by 6 publications

References 43 publications

Anesthesia management and challenges during interventional pulmonology procedures for central airway obstructions

Anesthesia management and challenges during interventional pulmonology procedures for central airway obstructions

Application of bronchoscopy in the diagnosis and treatment of peripheral pulmonary lesions in China: a national cross-sectional study

The Efficacy and Safety of Remimazolam Tosilate Versus Dexmedetomidine in Outpatients Undergoing Flexible Bronchoscopy: A Prospective, Randomized, Blind, Non-Inferiority Trial

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