Anesthesia considerations to reduce motion and atelectasis during advanced guided bronchoscopy

Area of Science:

• Anesthesiology
• Interventional Pulmonology
• Medical Imaging

Background:

• Anesthesia provider and proceduralist collaboration is vital for patient safety.
• Advanced bronchoscopy and interventional pulmonology highlight the importance of anesthesia protocols.
• Anesthesia-induced atelectasis is usually minor, but critical in guided bronchoscopic biopsy.

Purpose of the Study:

• To provide anesthesia recommendations for guided bronchoscopy.
• To optimize patient outcomes and procedural success.
• To minimize complications like atelectasis and imaging artifacts.

Main Methods:

• Recommended pre-oxygenation with an fraction of inspired oxygen (FiO2) of 0.6-0.8.
• Advocated for expeditious intubation with larger endotracheal tubes and non-depolarizing muscle relaxants.
• Suggested positive end-expiratory pressure (PEEP) up to 10-12 cm H2O and increased tidal volumes, with patient tolerance assessment.
• Emphasized breath-hold maneuvers at peak inspiration for intraprocedural imaging.

Main Results:

• Specific anesthesia protocols can reduce atelectasis and CT-to-body divergence.
• Optimized ventilation and breath-hold techniques minimize motion artifact.
• Improved image clarity and accuracy during guided bronchoscopy are achieved.

Conclusions:

• Adherence to recommended anesthesia practices facilitates successful lung biopsies.
• These measures can potentially reduce the need for repeat procedures, accelerating treatment.
• Anesthesiologist and proceduralist discretion are paramount for patient safety.