Goudra Basavana G, Singh Preet Mohinder, Borle Anuradha, Farid Nahla, Harris Kassem
Department of Anesthesiology and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA,
Lung. 2015 Aug;193(4):453-65. doi: 10.1007/s00408-015-9733-7. Epub 2015 Apr 29.
The bronchoscopic procedures have seen a remarkable increase in both numbers and complexity. Although many anesthesia providers have kept pace with the challenge, the practice is varied and frequently suboptimal. Shared airway during bronchoscopy poses unique challenges. The available reviews have tried to address this lacuna; however, these have frequently dealt with the technical aspects of bronchoscopy than anesthetic challenges. The present review provides evidence-based management insights into anesthesia for bronchoscopy-both flexible and rigid. A systematic approach toward pre-procedural evaluation and risk stratification is presented. The possible anatomical and physiological factors that can influence the outcomes are discussed. Pharmacological principles guiding sedation levels and appropriate selection of sedatives form the crux of safe anesthetic management. The newer and safer drugs that can have potential role in anesthesia for bronchoscopy in the near future are discussed. Ventilatory strategies during bronchoscopy for prevention of hypoxia and hypercarbia are emphasized.
支气管镜检查程序在数量和复杂性方面都有显著增加。尽管许多麻醉医生已经跟上了这一挑战，但实践情况各不相同，且常常不尽人意。支气管镜检查期间的共享气道带来了独特的挑战。现有的综述试图填补这一空白；然而，这些综述更多地涉及支气管镜检查的技术方面，而非麻醉挑战。本综述提供了关于支气管镜检查（包括可弯曲和硬质支气管镜检查）麻醉的循证管理见解。提出了一种针对术前评估和风险分层的系统方法。讨论了可能影响结果的解剖和生理因素。指导镇静水平和适当选择镇静剂的药理学原则是安全麻醉管理的关键。还讨论了在不久的将来可能在支气管镜检查麻醉中发挥潜在作用的更新、更安全的药物。强调了支气管镜检查期间预防缺氧和高碳酸血症的通气策略。
