Chapter 30 - Anesthesia for diagnostic bronchoscopic procedures

Summary

Diagnostic bronchoscopic procedures are performed every day by both pulmonologists and thoracic surgeons. Diagnostic bronchoscopy is indicated for airway exam, bronchioalveolar lavage, biopsy of airway lesions, autofluorescence bronchoscopy, and narrow band imaging. Endobronchial ultrasound (EBUS) is a minimally invasive procedure that was designed to evaluate mediastinal and hilar lymphadenopathy using a linear array ultrasound probe modified flexible bronchoscope. Electromagnetic navigational bronchoscopy (ENB) is a bronchoscopic procedure that utilizes the principle of GPS to allow the bronchoscopist to reach peripheral lung lesions adjacent to very small distal bronchi. Diagnostic bronchoscopy can be considered an urgent procedure where a definitive diagnosis and/or staging of a known cancer is needed to plan treatment. Advanced diagnostic bronchoscopy can be performed under moderate sedation, monitored anesthesia care or general anesthesia. EBUS and EMN are considered relatively safe procedures. Rare complications and morbidities which can occur are described in this chapter.