1 Division of Pulmonary and Critical Care, University of North Carolina, Chapel Hill, North Carolina; and.
Ann Am Thorac Soc. 2014 May;11(4):628-34. doi: 10.1513/AnnalsATS.201309-302FR.
Due to growing interest in management of central airway obstruction, rigid bronchoscopy is undergoing a resurgence in popularity among pulmonologists. Performing rigid bronchoscopy requires use of deep sedation or general anesthesia to achieve adequate patient comfort, whereas maintaining oxygenation and ventilation via an uncuffed and often open rigid bronchoscope requires use of ventilation strategies that may be unfamiliar to most pulmonologists. Available approaches include apneic oxygenation, spontaneous assisted ventilation, controlled ventilation, manual jet, and high-frequency jet ventilation. Anesthetic technique is partially dictated by the selected ventilation strategy but most often relies on a total intravenous anesthetic approach using ultra-short-acting sedatives and hypnotics for a rapid offset of action in this patient population with underlying respiratory compromise. Gas anesthetic may be used with the rigid bronchoscope, minimizing leaks with fenestrated caps placed over the ports, although persistent circuit leaks can make this approach challenging. Jet ventilation, the most commonly used ventilatory approach, may be delivered manually using a Sanders valve or via an automated ventilator at supraphysiologic respiratory rates, allowing for an open rigid bronchoscope to facilitate ease of moving tools in and out of the airway. Despite a patient population that often suffers from significant respiratory compromise, major complications with rigid bronchoscopy are uncommon and are similar among modern ventilation approaches. Choice of ventilation technique should be determined by local expertise and equipment availability. Appropriate patient selection and recognition of limitations associated with a given ventilation strategy are critical to avoid procedural-related complications.
由于对中央气道阻塞管理的兴趣日益浓厚，硬质支气管镜在肺病学家中重新流行起来。进行硬质支气管镜检查需要使用深度镇静或全身麻醉来实现患者的充分舒适，而通过未套囊且通常开放的硬质支气管镜维持氧合和通气则需要使用大多数肺病学家不熟悉的通气策略。可用的方法包括无呼吸氧合、自主辅助通气、控制通气、手动喷射和高频喷射通气。麻醉技术部分取决于所选的通气策略，但最常依赖于使用超短效镇静剂和催眠剂的全静脉麻醉方法，以便在有潜在呼吸功能障碍的患者群体中快速消除作用。硬质支气管镜可使用气体麻醉，通过在端口上放置带孔的盖子来最大程度减少泄漏，尽管持续的回路泄漏可能使这种方法具有挑战性。喷射通气是最常用的通气方法，可使用桑德斯阀手动提供，也可通过自动呼吸机以高于生理呼吸频率提供，允许开放硬质支气管镜便于轻松将工具进出气道。尽管患者群体经常患有严重的呼吸功能障碍，但硬质支气管镜的主要并发症并不常见，并且在现代通气方法中相似。通气技术的选择应取决于当地的专业知识和设备可用性。适当的患者选择和认识与特定通气策略相关的局限性对于避免与程序相关的并发症至关重要。
