Common controversies surrounding anesthesia for procedures in the Interventional Pulmonology Suite

The number of anesthetics for both simple diagnostic and complex therapeutic procedures being performed in non-operating room locations (NORA) in dedicated Interventional Pulmonology Suites have been increasing in the past few years. Anesthesiologists must be familiar with the demands necessitated by the procedures performed by the interventionists and tailor the anesthetic to create a still field while carefully considering the patient's altered pharmacokinetics and reduced cardio-pulmonary function and choose a technique that allows prompt recovery and early discharge in these patients, many of whom are elderly and frail. In this article we will address controversies surrounding the use of topical analgesia in patients already anesthetized by a TIVA technique and the questions of choice of muscle relaxants and reversal agents and standard of monitoring during these procedures.