Anesthesia for Bronchoscopy-An Update

The field of interventional pulmonology has grown immensely and is increasingly recognized as a subspecialty. The new procedures introduced in the last decade pose unique challenges and the anesthesia providers need to readapt to their specific demands. In this review, we have discussed extensively the pathophysiology, technical aspects, preprocedural preparation, anesthetic management and postprocedural challenges of many new procedures such as navigational bronchoscopy, endobronchial valve deployment and bronchial thermoplasty. Majority of these procedures are performed under general anesthesia with an endotracheal tube. Total intravenous anesthesia with rocuronium as a muscle relaxant seems to the standard US practice. Easy availability and proven safety and efficacy of sugammadex as a reversal agent of rocuronium has decreased the need for high dose remifentanil as an agent to avoid muscle relaxants. Additional research is available with regards to the utility of nebulized lidocaine and is discussed. Finally, two newer drugs administered for conscious sedation (typically without the need of an anesthesia provider) are likely to gain popularity in the future. Remimazolam is a new short acting benzodiazepine with relatively faster offset of clinical effect. Dexmedetomidine, a selective adrenergic agonist, is increasingly employed in bronchoscopy as a sedative during bronchoscopic procedures.