Anaesthesia for Bronchoscopy

airway bronchoscopy endoscopy safety sedation ventilation Nov 21, 2024

Take a deep breath - Anaesthesia for Bronchoscopy

It doesn’t get much more shared airway than this! Anaesthesia for bronchoscopy can be extremely challenging and anxiety-inducing. 😰 Complications during bronchoscopy include:
💨 Hypoxaemia
🚫 Airway obstruction
🗣️ Laryngospasm
💨 Bronchospasm
🩸 Bleeding
😱 Pneumothorax
🔥 Airway fire

But as always, there are skills and techniques to be learned to help ensure smooth sailing in your bronch list! 🚤

Bronchoscopies can be done using either a rigid or flexible scope:

🔩 Rigid bronchs normally require a general anaesthetic and are usually for diagnosis and treatment of intra and/or extra luminal obstruction.
🔭 Flexible bronchs can be done under sedation and are used for airway visualisation, with or without diagnostic and therapeutic interventions.

Anaesthesia techniques to help facilitate bronchoscopy include:

Topical agents:
💉 Typically lignocaine
👅 Focused on the posterior oral cavity and base of tongue
💨 Can be gargled, nebulised and/or sprayed
🎤 Bronchoscope can also be used to spray the vocal cords
⚠️ Potential for aspiration to occur after topicalisation due to relaxation of the pharyngeal and laryngeal muscles

Regional Anaesthesia:
🧠 Usually a superior laryngeal nerve block - requires precise positioning
🤧 Used to block the “cough” reflex
⚠️ Complications include tracheal, arterial or thyroid injection, haematoma, laryngeal nerve damage

Sedation:
💉 Usually light to moderate sedation
💊 Common agents include midazolam, fentanyl, propofol, remifentanil, dexmedetomidine, ketamine
👀 Close observation for hypotension, respiratory depression, hypoventilation and apnoea
🌬️ HFNO can be utilised to combat apnoeic periods

General Anaesthesia:
🌀 TIVA does not require inhalational agent, useful in bronchoscopy as ventilation is interrupted
💉 Cannula and fluid line must be visible at all times, patient must have at least 2 IVs
⚠️ Challenges with shared airway include circuit leaks and difficulties with ventilation
💨 Bronchoscopes can be used to aid oxygenation/ventilation during the procedure

Patients undergoing bronchoscopy generally have impaired lung function of varying degrees, with poorer oxygen reserves resulting in shorter safe apnoea time. ⏱️ They are usually well aware of their functional status, and can be highly anxious as a result. 😟 Clear and constant communication and reassurance are key in creating a comfortable, safe environment for our patients. 💬🧘‍♀️

Build Knowledge
Improve Safety

 

References:

Chadha, M., Kulshrestha, M., & Biyani, A. (2015). Anaesthesia for bronchoscopy. Indian journal of anaesthesia, 59(9), 565–573. https://doi.org/10.4103/0019-5049.165851

Lentini C, Granlund B. Anesthetic Considerations for Bronchoscopic Procedures. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572074/

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