Anesthesia and Bronchoscopy

Anesthesia and Bronchoscopy

Complications of bronchoscopy: comparison of rigid bronchoscopy under general anesthesia and flexible fiberoptic bronchoscopy under topical anesthesia

https://www.ncbi.nlm.nih.gov/pubmed/7471862

Landmark Article

Reference: Lukomsky GI, Ovchinnikov AA, Bilal A. Complications of bronchoscopy: comparison of rigid bronchoscopy under general anesthesia and flexible fiberoptic bronchoscopy under topical anesthesia. Chest. 1981;79(3):316-21.

Background: One of the first comparisons of flexible bronchoscopy with topical analgesia and rigid bronchoscopy with general anesthesia

PICO:

Populations:

  • Russian population with indication for bronchoscopy

Intervention:

  • Bronchoscopy with either rigid bronchoscopy or flexible bronchoscopy

Comparison:

  • Therapeutic outcomes comparing flexible bronchoscopy with topical anesthesia to rigid bronchoscopy with general anesthesia

Outcome:

  • Complications within the first 24 hours were compared

Take Home: For major therapeutic interventions, rigid bronchoscopy with general anesthesia is the technique of choice


 American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients

https://www.ncbi.nlm.nih.gov/pubmed/22045879

Review

Reference: Wahidi MM, Jain P, Jantz M, et al. American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients. Chest. 2011;140(5):1342-1350.

Summary: ACCP consensus statement on bronchoscopy and sedation. Bronchoscopy can be done with or without sedation, but sedation and analgesia is recommended for patient comfort.


 Sedation in Bronchoscopy: A Review

https://www.ncbi.nlm.nih.gov/pubmed/29433726

Review

Reference: Mccambridge AJ, Boesch RP, Mullon JJ. Sedation in Bronchoscopy: A Review. Clin Chest Med. 2018;39(1):65-77.

Summary: Review of sedation techniques and medications for bronchoscopy. This includes pediatric bronchoscopy, flexible bronchoscopy, and rigid bronchoscopy


 Anesthesia and Upper and Lower Airway Management for Advanced Diagnostic and Therapeutic Bronchoscopy

https://www.advancesinanesthesia.com/article/S0737-6146(14)00012-4/abstract

Review

Reference: Anesthesia and Upper and Lower Airway Management for Advanced Diagnostic and Therapeutic Bronchoscopy; Abdelmalak B, Sethi S and Gildea T. Advances in Anesthesia. 2014;32(1):71 – 87.

Summary: A review of anesthesia considerations for advanced diagnostic and therapeutic bronchoscopic procedures by the Cleveland Clinic.


 Anesthetic considerations for bronchoscopic procedures: a narrative review based on the Cleveland Clinic experience

https://www.ncbi.nlm.nih.gov/pubmed/31463144

Review

Reference: Galway U, Zura A, Khanna S, Wang M, Turan A, Ruetzler K. Anesthetic considerations for bronchoscopic procedures: a narrative review based on the Cleveland Clinic experience. J Thorac Dis. 2019;11(7):3156-3170.

Summary: An updated review of anesthesia considerations for advanced diagnostic and therapeutic bronchoscopic procedures by the Cleveland Clinic.


 Anesthesia for the patient with tracheal stenosis

https://www.ncbi.nlm.nih.gov/pubmed/20400046

Review

Reference: Daumerie G, Su S, Ochroch EA. Anesthesia for the patient with tracheal stenosis. Anesthesiol Clin. 2010;28(1):157-74.

Summary: A review of the physiology, anatomy, and anesthesia considerations in tracheal stenosis.


 Jet Ventilation during Rigid Bronchoscopy in Adults: A Focused Review

https://www.ncbi.nlm.nih.gov/pubmed/27847813

Review

Reference: Putz L, Mayné A, Dincq AS. Jet Ventilation during Rigid Bronchoscopy in Adults: A Focused Review. Biomed Res Int. 2016;2016:4234861.

Summary: A review of the technique and requirements of jet ventilation during rigid bronchoscopy.


 A Randomized Trial of 1% vs 2% Lignocaine by the Spray-as-You-Go Technique for Topical Anesthesia During Flexible Bronchoscopy

https://www.ncbi.nlm.nih.gov/pubmed/25811287

Clinical Trial

Reference: Kaur H, Dhooria S, Aggarwal AN, Gupta D, Behera D, Agarwal R. A Randomized Trial of 1% vs 2% Lignocaine by the Spray-as-You-Go Technique for Topical Anesthesia During Flexible Bronchoscopy. Chest. 2015;148(3):739-745.

Background: Prior to this article, there was no consensus on the use of 1% vs 2% lidocaine in flexible bronchoscopy. This was a single center randomized control trial comparing 1% vs 2% lidocaine.

PICO:

Populations:

  • Patients aged 12-90 who underwent diagnostic bronchoscopy without hemodynamic instability or hypoxia at a center in India

Intervention:

  • 1% vs 2% lidocaine was compared in terms of cough suppression efficacy

Comparison:

  • 1% vs 2% lidocaine was compared in terms of cough suppression efficacy

Outcome:

  • 1% lidocaine achieved the same results as 2%, but at a lower total dose of lidocaine

Take Home: 1% lidocaine should be used during flexible bronchoscopy.


 Dexmedetomidine-fentanyl versus propofol-fentanyl in flexible bronchoscopy: A randomized study

https://www.ncbi.nlm.nih.gov/pubmed/27347086

Clinical Trial

Reference: Yuan F, Fu H, Yang P, et al. Dexmedetomidine-fentanyl versus propofol-fentanyl in flexible bronchoscopy: A randomized study. Exp Ther Med. 2016;12(1):506-512.

Background: General anesthesia or conscious sedation with opiates and benzodiazepines are generally standard of care, but dexmedetomidine has not been studied in this use. This study was done to determine if it could be an alternative.

PICO:

Populations:

  • 100 patients undergoing bronchoscopy at a Chinese hospital were enrolled

Intervention:

  • Bronchoscopic sedation medications

Comparison:

  • Propofol with fentanyl were compared to dexmedetomidine with fentanyl

Outcome:

  • Outcomes were measured with the Modified observer’s assessment of alertness/sedation scale

Take Home: Dexmedetomidine with fentanyl provided at least similar, if not superior results. Oxygen saturation was higher, but recovery was longer.


 The death of a healthy volunteer in a human research project: implications for Australian clinical research

https://www.ncbi.nlm.nih.gov/pubmed/9612458

Landmark Article/Case Report

Reference: Day RO, Chalmers DR, Williams KM, Campbell TJ. The death of a healthy volunteer in a human research project: implications for Australian clinical research. Med J Aust. 1998;168(9):449-51.

Summary: This case report and review describes the background of one of the first deaths associated with lidocaine toxicity during bronchoscopy and the lessons learned from it.


 Methemoglobinemia in bronchoscopy: a case series and a review of the literature

https://www.ncbi.nlm.nih.gov/pubmed/23857198

Case Report

Reference: Brown C, Bowling M. Methemoglobinemia in bronchoscopy: a case series and a review of the literature. J Bronchology Interv Pulmonol. 2013;20(3):241-6.

Summary: A case report and review of the literature of methemoglobinemia complicating bronchoscopy.