Hensley's Practical Approach to Cardiothoracic Anesthesia

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26. Anesthetic Management for Interventional Pulmonology Procedures

4. Additional considerations: CT-to-body divergence is a mismatch in lung volumes be tween the high-resolution CT acquired at maximal inspiration in the preoperative period and at the end of expiration while mechanically ventilated. This is minimized by using the proposed ventilatory settings. Lateral positioning has been suggested to decrease atelec tasis and obviate the high-pressure high-volume ventilatory need; 12 however, this is not clinically feasible. 5. Complications: Similar to EBUS. In particular, due to elevated intrathoracic pressures, hypotension, and pneumothorax CLINICAL PEARL CT-to-body divergence is the limiting factor to good sampling with the least associated complications, especially bleeding. E. Rigid Bronchoscopy 1. Procedure: A rigid bronchoscope is introduced through the vocal cords and above the carina, to visualize the trachea and proximal bronchi. 2. Indications: Hemoptysis, large airway obstruction, foreign body, respiratory papillomato sis, airway dilation, or stent placement or removal 3. Anesthesia: General anesthesia with TIVA, with or without paralysis. While spontaneous ventilation is possible, jet ventilation is frequently used 13 with paralysis. 4. Additional considerations: The rigid bronchoscope effectively acts as an airway device while in place; upon its removal, it is sometimes necessary to place a temporary airway, such as an ETT or SGA, during emergence from anesthesia, depending on patient anatomy and level of sedation. Mask ventilation is also a possibility. 5. Complications: Barotrauma, airway obstruction, pneumothorax, pneumomediastinum, dental injury, tongue injury, tracheal injury, esophageal injury, hypoxia, hypercapnia, in ability to ventilate CLINICAL PEARL General anesthesia with paralysis is commonly used for this procedure to facilitate the placement of the rigid bronchoscope and jet ventilation. F. Pleuroscopy 1. Procedure: Also known as medical thoracoscopy, this procedure involves placing a camera through the chest wall and into the pleural space for diagnostic and therapeutic purposes. 2. Indications: Pleurodesis, pleural biopsy, pleural fluid drainage 3. Anesthesia: Typically, general anesthesia is used, with or without selective lung ventilation; however, deep sedation with regional analgesia is also a good option in certain candidates. 6 4. Complications: Air leak, subcutaneous emphysema, pneumothorax, hemorrhage, air em bolism, reexpansion pulmonary edema

Copyright © 2024 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. CLINICAL PEARL Regional analgesia and proper patient selection are instrumental in the success of sedation for these procedures. Paravertebral, erector spinae, and midtransverse process to pleura (MTP) block are good analgesic options. 6