Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA.
Can J Anaesth. 2018 Jul;65(7):822-836. doi: 10.1007/s12630-018-1121-3. Epub 2018 Apr 5.
Interventional pulmonology is a growing subspecialty of pulmonary medicine with flexible and rigid bronchoscopies increasingly used by interventional pulmonologists for advanced diagnostic and therapeutic purposes. This review discusses different technical aspects of anesthesia for interventional pulmonary procedures with an emphasis placed on pharmacologic combinations, airway management, ventilation techniques, and common complications.
Relevant medical literature was identified by searching the PubMed and Google Scholar databases for publications on different anesthesia topics applicable to interventional pulmonary procedures. Cited literature included case reports, original research articles, review articles, meta-analyses, guidelines, and official society statements.
Interventional pulmonology is a rapidly growing area of medicine. Anesthesiologists need to be familiar with different considerations required for every procedure, particularly as airway access is a shared responsibility with pulmonologists. Depending on the individual case characteristics, a different selection of airway method, ventilation mode, and pharmacologic combination may be required. Most commonly, airways are managed with supraglottic devices or endotracheal tubes. Nevertheless, patients with central airway obstruction or tracheal stenosis may require rigid bronchoscopy and jet ventilation. Although anesthetic approaches may vary depending on factors such as the length, complexity, and acuity of the procedure, the majority of patients are anesthetized using a total intravenous anesthetic technique.
It is fundamental for the anesthesia provider to be updated on interventional pulmonology procedures in this rapidly growing area of medicine.
介入肺病学是肺病学的一个不断发展的亚专科，介入肺病学家越来越多地使用软硬支气管镜进行高级诊断和治疗。这篇综述讨论了介入性肺程序麻醉的不同技术方面，重点介绍了药理学组合、气道管理、通气技术和常见并发症。
通过搜索 PubMed 和 Google Scholar 数据库中与介入性肺程序相关的麻醉主题出版物，确定了相关医学文献。引用的文献包括病例报告、原始研究文章、综述文章、荟萃分析、指南和官方学会声明。
介入肺病学是一个快速发展的医学领域。麻醉师需要熟悉每个程序所需的不同考虑因素，特别是气道的获取是与肺病学家共同承担的责任。根据个体病例的特点，可能需要选择不同的气道方法、通气模式和药物组合。最常见的是，气道采用声门上装置或气管内导管进行管理。然而，对于中央气道阻塞或气管狭窄的患者，可能需要进行硬支气管镜检查和射流通气。尽管麻醉方法可能因手术的长度、复杂性和紧迫性等因素而有所不同，但大多数患者都采用全静脉麻醉技术进行麻醉。
在这个快速发展的医学领域，麻醉提供者必须了解介入肺病学程序，这一点至关重要。
