Anesthesia for interventional bronchoscopy

Perioperative anesthesiologic management of patients presenting for interve ntional bronchoscopy requires a multidisciplinary approach with optimal com munication, adequate preoperative evaluation and preparation of patients, e xperience in alternative ventilatory techniques, availability of extended m onitoring, and access to postoperative intensive care treatment including m echanical ventilation. Preoperative evaluation aims at identifying patients at risk for perioperative adverse events, especially regarding cardiovascu lar and pulmonary morbidity and optimizing ongoing therapies. Premedication strategies as well as guidelines concerning preoperative fasting and preve ntion of pulmonary aspiration are discussed. Interventional bronchoscopy is usually performed using topical local anesthesia for awake fiberoptic bron choscopy and general anesthesia for rigid bronchoscopy. Ventilatory support can be provided by various modes, including spontaneous assisted ventilati on using the laryngeal mask airway, endotracheal tubes or the rigid broncho scope, intermittent positive pressure ventilation, and jet ventilation. Dur ing interventional bronchoscopy, short episodes of hypoxemia and hypercarbi a are frequent problems which usually may be controlled with modification o f the applied ventilation technique, whereas major hemorrhage and pneumotho rax are more serious but fortunately rare complications.