Anesthesia considerations to reduce motion and atelectasis during advanced guided bronchoscopy

BMC Pulmonary Medicine

Karen A. Phillips¹  Michael A. Pritchett²  Krish Bhadra³  Scott Skibo⁴  Kelvin Lau⁵ 

[1] Anesthesiologist and Intensivist, Medtronic, 2101 Faraday Avenue, 92008, Carlsbad, CA, USA;Chest Center of the Carolinas at First Health, President of the Society for Advanced Bronchoscopy, FirstHealth of the Carolinas and Pinehurst Medical Clinic, 205 Page Road, 28374, Pinehurst, NC, USA;Interventional Pulmonology, CHI Memorial Rees Skillern Cancer Institute, 725 Glenwood Dr E-500, 37401, Chattanooga, TN, USA;Interventional Thoracic Oncology, Pulmonary Critical Care, Haywood Regional Medical Center (A Duke LifePoint Hospital), 262 Leroy George Drive, 28721, Clyde, NC, USA;Thoracic Surgery, St. Bartholomew’s Hospital, West Smithfield, EC1A 7BE, London, UK;

关键词: Atelectasis;    General anesthesia;    Electromagnetic navigation bronchoscopy;    Radial endobronchial ultrasound;    Image-guided bronchoscopy;    Computed tomography;    Divergence;    Lung cancer;   

DOI  :  10.1186/s12890-021-01584-6

来源: Springer

【 摘 要 】

Partnership between anesthesia providers and proceduralists is essential to ensure patient safety and optimize outcomes. A renewed importance of this axiom has emerged in advanced bronchoscopy and interventional pulmonology. While anesthesia-induced atelectasis is common, it is not typically clinically significant. Advanced guided bronchoscopic biopsy is an exception in which anesthesia protocols substantially impact outcomes. Procedure success depends on careful ventilation to avoid excessive motion, reduce distortion causing computed tomography (CT)-to-body-divergence, stabilize dependent areas, and optimize breath-hold maneuvers to prevent atelectasis. Herein are anesthesia recommendations during guided bronchoscopy. An FiO2 of 0.6 to 0.8 is recommended for pre-oxygenation, maintained at the lowest tolerable level for the entire the procedure. Expeditious intubation (not rapid-sequence) with a larger endotracheal tube and non-depolarizing muscle relaxants are preferred. Positive end-expiratory pressure (PEEP) of up to 10–12 cm H2O and increased tidal volumes help to maintain optimal lung inflation, if tolerated by the patient as determined during recruitment. A breath-hold is required to reduce motion artifact during intraprocedural imaging (e.g., cone-beam CT, digital tomosynthesis), timed at the end of a normal tidal breath (peak inspiration) and held until pressures equilibrate and the imaging cycle is complete. Use of the adjustable pressure-limiting valve is critical to maintain the desired PEEP and reduce movement during breath-hold maneuvers. These measures will reduce atelectasis and CT-to-body divergence, minimize motion artifact, and provide clearer, more accurate images during guided bronchoscopy. Following these recommendations will facilitate a successful lung biopsy, potentially accelerating the time to treatment by avoiding additional biopsies. Application of these methods should be at the discretion of the anesthesiologist and the proceduralist; best medical judgement should be used in all cases to ensure the safety of the patient.

【 授权许可】

CC BY