Tacchi Giovanni, Frasca Luca, Longo Filippo, Sarubbi Antonio, Marziali Valentina, Suriano Ilaria, Costa Fabio, Crucitti Pierfilippo
Thoracic Surgery Unit, Campus Bio-Medico University, Rome, Italy.
PhD Course in Microbiology, Immunology, Infectious Diseases and Transplants (MIMIT), University of Rome Tor Vergata, Rome, Italy.
J Thorac Dis. 2025 Apr 30;17(4):2655-2661. doi: 10.21037/jtd-24-1715. Epub 2025 Apr 27.
Central airway obstruction (CAO) in adults may be a life‑threatening condition requiring rigid bronchoscopy (RB). This procedure is remarkably demanding and challenging both for the anesthesiologist and the interventional bronchoscopist. The more suitable and comfortable anesthetic management is not clear.
Some authors reported brief experiences with ketamine administration. We collected the main reports about ketamine usage in adult thoracic endoscopy-both flexible and rigid. Then we briefly reported our methodology describing our total intravenous anesthesia (TIVA) with ketamine usage combined with spontaneous assisted ventilation (SAV) in RB and introducing our initial experience with this procedure. Finally, we draw a picture of our operator's feelings and perceptions.
There are very few reports about ketamine administration in RB for adult patients. Our ketamine-remifentanil-propofol protocol combined with SAV yielded a very remarkable comfort to the surgeon and anesthesiologist because of the patient's deep stillness and the very infrequent desaturation occurrence.
Operator's comfort during RB is of paramount importance in order to achieve the therapeutic goal and maintain patient's safety. Ketamine-remifentanil-propofol TIVA seems to be safe and feasible for anesthetic management of RB in adult. This drug regimen may be reliable in several possible interventions for malignant and benignant conditions.
成人中央气道梗阻（CAO）可能是一种危及生命的状况，需要进行硬质支气管镜检查（RB）。该操作对麻醉医生和介入支气管镜医生来说要求极高且极具挑战性。目前尚不清楚哪种麻醉管理方式更合适、更舒适。
一些作者报告了使用氯胺酮的简短经验。我们收集了关于氯胺酮在成人胸段内镜检查（包括可弯曲和硬质内镜）中应用的主要报告。然后我们简要介绍了我们的方法，描述了在硬质支气管镜检查中使用氯胺酮并结合自主辅助通气（SAV）的全静脉麻醉（TIVA），并介绍了我们在此操作中的初步经验。最后，我们描述了操作人员的感受和看法。
关于在成人患者的硬质支气管镜检查中使用氯胺酮的报告非常少。我们的氯胺酮-瑞芬太尼-丙泊酚方案结合自主辅助通气，由于患者深度静止且很少出现去饱和现象，给外科医生和麻醉医生带来了非常显著的舒适感。
为了实现治疗目标并维持患者安全，硬质支气管镜检查期间操作人员的舒适度至关重要。氯胺酮-瑞芬太尼-丙泊酚全静脉麻醉似乎对成人硬质支气管镜检查的麻醉管理是安全可行的。这种药物方案在针对恶性和良性疾病的几种可能干预中可能是可靠的。
