Anesthetic considerations for medical pleuroscopy

Area of Science:

• Interventional Pulmonology
• Thoracic Surgery
• Anesthesiology

Background:

• Pleuroscopy is a crucial procedure in interventional pulmonology, essential for fellowship training.
• It is primarily used for diagnosing undiagnosed pleural effusions via parietal pleural biopsies, achieving high diagnostic yields comparable to VATS.
• Other applications include pleurodesis, indwelling pleural catheter insertion, and decortication for empyema.

Purpose of the Study:

• To discuss the technical aspects of pleuroscopy.
• To highlight peri-operative considerations for managing patients undergoing pleuroscopy, especially those with comorbidities.
• To review the role of anesthesia, including monitored anesthesia care (MAC), ultrashort sedatives, and regional anesthesia techniques.

Main Methods:

• Review of technical aspects of pleuroscopy.
• Discussion of peri-operative management strategies for proceduralists and anesthesiologists.
• Summary of current data on regional anesthesia techniques in pleuroscopy.

Main Results:

• Pleuroscopy demonstrates a high diagnostic yield (>92%) for pleural effusions.
• An increasing number of pleuroscopy procedures are performed with anesthesiologist-provided monitored anesthesia care (MAC).
• Emphasis on managing patients with significant comorbidities in a non-operating room setting.

Conclusions:

• Effective peri-operative management by proceduralists and anesthesiologists is vital for patients undergoing pleuroscopy, particularly those with comorbidities.
• Ultrashort sedatives and regional anesthesia techniques are important considerations for optimizing patient care during pleuroscopy.
• Further research into regional anesthesia techniques for pleuroscopy is warranted.