• Coughing
• Efficacy
• Endobronchial ultrasound-guided transbronchial needle aspiration
• Lignocaine
• Safety
• Topical anesthesia

• Humans
• Male
• Lidocaine/administration & dosage
• Lidocaine/adverse effects
• Female
• Patient Satisfaction
• Anesthetics, Local/administration & dosage
• Anesthetics, Local/adverse effects
• Double-Blind Method
• Middle Aged
• Prospective Studies
• Bronchoscopy/methods
• Anesthesia, General/methods
• Cough/prevention & control
• Cough/epidemiology
• Aged
• Adult
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Anesthesia, Local/methods
• Administration, Topical

• Blood Pressure
• Bronchoscopy
• Endoscopy
• Propofol

• Humans
• Propofol/administration & dosage
• Propofol/adverse effects
• Double-Blind Method
• Bronchoscopy/methods
• Adult
• Middle Aged
• Prospective Studies
• Aged
• Male
• Female
• Adolescent
• Young Adult
• Randomized Controlled Trials as Topic
• Aged, 80 and over
• Anesthesia, General/methods
• Anesthetics, Intravenous/administration & dosage
• Anesthetics, Intravenous/adverse effects
• Heart Rate/drug effects
• Blood Pressure/drug effects
• Cyclopropanes

• National Natural Science Foundation of China
• Shanghai Fourth People's Hospital, School of Medicine, Tongji University
• Natural Science Foundation of Shanghai

• Humans
• Remifentanil/administration & dosage
• Conscious Sedation/methods
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/methods
• Prospective Studies
• Lung Neoplasms/pathology
• Midazolam/administration & dosage
• Male
• Patient Satisfaction
• Female
• Standard of Care
• Middle Aged
• Propofol/administration & dosage
• Hypnotics and Sedatives/administration & dosage
• Fentanyl/administration & dosage
• Bronchoscopy/methods
• Aged
• Adult

• Humans
• Propofol
• Prospective Studies
• Deep Sedation/methods
• Endoscopic Ultrasound-Guided Fine Needle Aspiration
• Hypnotics and Sedatives
• Cough/prevention & control
• Cough/etiology
• Lidocaine

• drug safety
• target identification
• randomized controlled trials

• Humans
• Midazolam/adverse effects
• Hypnotics and Sedatives/adverse effects
• Bronchoscopy/adverse effects
• Bronchoscopy/methods
• Prospective Studies
• Double-Blind Method
• Benzodiazepines/adverse effects
• Drug-Related Side Effects and Adverse Reactions

• 2020R1A5A2017476 The National Research Foundation of Korea (NRF) grant

• Humans
• Bronchoscopy/adverse effects
• Bronchoscopy/methods
• Anesthesia, General
• Lung
• Surveys and Questionnaires
• Pulmonary Medicine/methods

Extracorporeal membrane oxygenation (ECMO) assists blood circulation and gas exchange via a heart–lung machine. ECMO is used mainly in intensive care units as bridging therapy until heart and respiratory failure can be addressed or until transplantation can be performed. ECMO is sometimes used during surgery under general anaesthesia, depending on the patient’s underlying diseases and the nature of the operation. If the oxygen supply and carbon dioxide removal capacity are limited, venovenous (VV)-ECMO can be helpful. Here, we describe the use of VV-ECMO for surgical resection of an endotracheal mass through rigid bronchoscopy in a patient who developed decompensating dyspnoea due to central airway obstruction (CAO).

• Extracorporeal membrane oxygenation
• airway management
• airway obstruction
• bronchoscopy
• lung neoplasm
• trachea

• effect concentration
• fibreoptic bronchoscopy
• monitored anesthesia care
• remifentanil
• severe tracheal stenosis
• spontaneous breathing

• Biomarkers
• Genomic laboratory hub
• Genomic testing in lung cancer
• Molecular
• Next‑generation sequencing
• Targeted therapy

• COVID-19
• Carcinoma, Non-Small-Cell Lung/diagnosis
• Carcinoma, Non-Small-Cell Lung/genetics
• Carcinoma, Non-Small-Cell Lung/pathology
• Humans
• Lung Neoplasms/diagnosis
• Lung Neoplasms/genetics
• Lung Neoplasms/pathology
• Molecular Diagnostic Techniques
• Pandemics
• United Kingdom

• MR/T02481X/1 Medical Research Council

• adult anaesthesia
• bronchoscopy
• chronic airways disease
• endoscopic surgery
• respiratory tract tumours

• Anesthesia
• Bronchoscopy/methods
• China
• Humans
• Hypoxia/etiology
• Piperidines
• Prospective Studies
• Randomized Controlled Trials as Topic
• Remifentanil
• Sufentanil
• Tracheal Stenosis

• Shanghai Municipal Health Commission

• bronchoscopy
• esketamine
• hypoxemia
• propofol
• sufentanil

Bronchoscopy treatments of central airway obstruction (CAO) under general anesthesia are high-risky procedures, and posing a giant challenge to the anesthesiologists. We summarized and analyzed our clinical experience in patients with CAO undergoing flexible or rigid bronchoscopy, to estimate the safety of skeletal muscle relaxants application and the traditional Low-frequency ventilation.

Clinical data of 375 patients with CAO who underwent urgent endoscopic treatments in general anesthesia from January 2016 to October 2019 were retrospectively reviewed. The use ratio of skeletal muscle relaxants, dose of skeletal muscle relaxants used, the incidence of perioperative adverse events, adequacy of ventilation and gas exchange, post-operative recovery between rigid bronchoscopy and flexible bronchoscopy therapy, and risk factors for postoperative ICU admission were evaluated.

Of the 375 patients with CAO, 204 patients were treated with flexible bronchoscopy and 171 patients were treated with rigid bronchoscopy. Muscle relaxants were used in 362 of 375 patients (including 313 cisatracurium, 45 rocuronium, 4 atracurium, and 13 unrecorded). The usage rate of muscle relaxants (96.5% in total) was very high in patients with CAO who underwent either flexible bronchoscopy (96.6%) or rigid bronchoscopy (96.5%) therapy. The dosage of skeletal muscle relaxants (Cisatracium) used was higher in rigid bronchoscopy compared with flexible bronchoscopy therapy (10.8 ± 3.8 VS 11.6 ± 3.6 mg, respectively, p < 0.05). No patient suffered the failure of ventilation, bronchospasm and intraoperative cough either in flexible or rigid bronchoscopy therapy. Hypoxemia was occurred in 13 patients (8 in flexible, 5 in rigid bronchoscopy) during the procedure, and reintubation after extubation happened in 2 patients with flexible bronchoscopy. Sufficient ventilation was successfully established using the traditional Low-frequency ventilation with no significant carbon dioxide accumulation and hypoxemia occurred both in flexible and rigid bronchoscopy group (p > 0.05). Three patients (1 in flexible and 2 in rigid) died, during the post-operative recovery, and the higher grade of American Society of Anesthesiologists (ASA) and obvious dyspnea or orthopnea were the independent risk factors for postoperative ICU admission.

The muscle relaxants and low-frequency traditional ventilation can be safely used both in flexible and rigid bronchoscopy treatments in patients with CAO. These results may provide strong clinical evidence for optimizing the anesthesia management of bronchoscopy for these patients.

• Anesthesia management
• Bronchoscopy
• Central airway obstruction
• Muscle relaxants
• Traditional low-frequency ventilation

• 2019-nCoV
• COVID-19
• airway management
• coronavirus
• lung cancer
• thoracic anesthesia

• Anesthesia, Cardiac Procedures/methods
• Anesthesia, Cardiac Procedures/standards
• COVID-19/epidemiology
• COVID-19/prevention & control
• Cross Infection/epidemiology
• Cross Infection/prevention & control
• Disease Outbreaks/prevention & control
• Humans
• Occupational Exposure/prevention & control
• Occupational Exposure/standards
• Personal Protective Equipment/standards

• Airway Obstruction
• Bronchoscope
• General Anesthesia
• Intravenous Anesthesia
• Propofol
• Remifentanil

• Asthma
• bronchial thermoplasty
• bronchospasm
• general anesthesia
• nonoperating room procedures
• pharmacotherapy

• Adverse events
• Bronchoscopy
• Flexible
• Foreign body aspiration
• Risks

• anesthesia
• flexible bronchoscopy
• high jet frequency ventilation
• intratracheal tumor
• resection
• suction catheter

• Aged
• Bronchoscopy/methods
• Female
• High-Frequency Jet Ventilation
• Humans
• Male
• Middle Aged
• Tracheal Neoplasms/surgery

To evaluate current practices in sedation for bronchoscopy in Latin America.

This was an anonymous survey of select members of the Latin American Thoracic Association. The questionnaire, made available online from November of 2015 through February of 2016, was designed to collect data on demographic characteristics; type of facility (public or private); type/volume of bronchoscopies; type of sedation; and type of professional administering the sedation.

We received 338 completed questionnaires from 19 countries; 250 respondents (74.0%) were male. The mean respondent age was 36.0 ± 10.5 years. Of the 338 respondents, 304 (89.9%) were pulmonologists; 169 (50.0%) worked at public facilities; and 152 (45.0%) worked at teaching facilities. All of the respondents performed diagnostic fiberoptic bronchoscopy, 206 (60.9%) performed therapeutic fiberoptic bronchoscopy, 125 (37.0%) performed rigid bronchoscopy, 37 (10.9%) performed endobronchial ultrasound, and 3 (0.9%) performed laser therapy/thermoplasty/cryotherapy. Sedation for bronchoscopy was employed by 324 respondents (95.6%). Of the 338 respondents, 103 (30.5%) and 96 (28.4%) stated, respectively, that such sedation should “usually” and “never” be administered by a bronchoscopist; 324 (95.9%) supported training bronchoscopists in sedation. Sedation administered by a bronchoscopist was reported by 113 respondents, conscious sedation being employed by 109 (96.2%). The use of benzodiazepines, propofol, and opiates was reported, respectively, by 252 (74.6%), 179 (52.9%), and 132 (39.0%) of the 338 respondents. Deep sedation and general anesthesia were more common at private facilities.

The consensus seems to be that a well-trained bronchoscopist can safely administer sedation for bronchoscopy. However, approximately 40% of bronchoscopists do not do so regularly.

• Drug-related side effects and adverse reactions
• Off-label use
• Pharmacodynamics
• Pharmacokinetics
• Propofol infusion syndrome

We conducted a randomized clinical trial to determine whether adjunctive lidocaine diminishes the incidence of adverse effects in pediatric patients sedated with ketamine.

This case‐control study involved 586 consecutive pediatric patients necessitating anesthesia. Then systolic blood pressure, heart rate, respiratory rate, and blood oxygen saturation were observed. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea nitrogen (BUN), and creatinine (Cr) levels were tested. General dose of ketamine, the time of onset and duration of anesthesia and postoperative recovery, anesthesia effect, and adverse reaction were subsequently compared. High‐performance liquid chromatography was employed to detect ketamine concentration at different time points after administration, and the postoperative cognition function was further evaluated.

Intra‐ and post‐operation, the rising degree of ALT, AST, BUN, and Cr in patients treated with ketamine was higher than those in patients treated with the ketamine‐lidocaine complex. General dose of ketamine, the time of onset and duration of anesthesia, postoperative recovery time, and the incidence rate of adverse reaction in patients treated with ketamine‐lidocaine complex were lower, but the concentration of ketamine was higher compared to the patients treated with ketamine. In patients treated with the ketamine‐lidocaine complex, elimination half‐life of ketamine was prolonged, the area under curve was increased, and the plasma clearance rate was decreased relative to those with ketamine alone.

Ketamine combined with lidocaine may be beneficial in shortening the onset of anesthesia, promoting postoperative awake, prolonging elimination half‐life, increasing area under curve, and decreasing plasma clearance rate and incidence of adverse reactions.

• injectable anesthesia
• ketamine
• lidocaine
• pediatric anesthesia

• Bronchoscopy
• Cystic fibrosis
• Lung transplantation
• Propofol
• Sedation

Several studies have reported the use of dexmedetomidine (DEX) plus opioids for flexible bronchoscopy in both adults and children. To determine whether DEX plus sufentanil (SF) is safe for children, 142 children undergoing flexible bronchoscopy were assigned to one of three groups, each of which received the same SF loading dose and similar DEX and SF maintenance doses, but different loading doses of DEX: DS1 (DEX 0.5 μg·kg^–1), DS2 (DEX 1.0 μg·kg^–1), and DS3 (DEX 1.5 μg·kg^–1). The Ramsay sedation scale was maintained at 3 in all groups. Results showed that anesthesia onset time was shorter, and the perioperative hemodynamic profile was more stable, in the DS3 group. The number of intraoperative movements was also lowest in the DS3 group. The time to first dose of rescue midazolam and lidocaine was significantly longer, but the total corresponding accumulated doses were lower in the DS3 group. Although the time to recovery prior to discharge from the post anesthesia care unit was longer, the overall incidence of tachycardia was lower in the DS3 group, and it received the highest bronchoscopist satisfaction score among the three groups. We therefore conclude that high-dose DEX plus SF can be safely and efficaciously used in children undergoing flexible bronchoscopy.

• dexmedetomidine
• flexible bronchoscopy
• pediatric
• sufentanil

• Airway Management/methods
• Anesthesia/methods
• Bronchoscopy/methods
• Humans
• Pulmonary Medicine
• Ventilators, Mechanical

• Anesthetic management
• Asthma
• Bronchial thermoplasty
• Bronchoscopy
• General anesthesia

• Adult
• Anesthesia, General/methods
• Asthma/therapy
• Bronchial Spasm/etiology
• Bronchial Thermoplasty/methods
• Bronchoscopy/methods
• Cough/etiology
• Feasibility Studies
• Female
• Humans
• Male
• Middle Aged
• Respiratory Sounds/etiology
• Retrospective Studies

• dexmedetomidine
• flexible bronchoscopy
• hemodynamic stability
• paediatric
• remifentanil

• Anesthesia Recovery Period
• Bronchoscopy/methods
• Child
• Dexmedetomidine/administration & dosage
• Dexmedetomidine/adverse effects
• Dexmedetomidine/therapeutic use
• Dose-Response Relationship, Drug
• Drug Therapy, Combination
• Female
• Hemodynamics
• Humans
• Hypnotics and Sedatives/administration & dosage
• Hypnotics and Sedatives/adverse effects
• Hypnotics and Sedatives/therapeutic use
• Lidocaine/administration & dosage
• Male
• Midazolam/administration & dosage
• Movement/drug effects
• Piperidines/administration & dosage
• Piperidines/adverse effects
• Piperidines/therapeutic use
• Remifentanil
• Retrospective Studies

The indications for rigid bronchoscopy for interventional pulmonology have increased and include stent placements and transbronchial cryobiopsy procedures. The shared airway between anesthesiologist and pulmonologist and the open airway system, requiring specific ventilation techniques such as jet ventilation, need a good understanding of the procedure to reduce potentially harmful complications. Appropriate adjustment of the ventilator settings including pause pressure and peak inspiratory pressure reduces the risk of barotrauma. High frequency jet ventilation allows adequate oxygenation and carbon dioxide removal even in cases of tracheal stenosis up to frequencies of around 150 min⁻¹; however, in an in vivo animal model, high frequency jet ventilation along with normal frequency jet ventilation (superimposed high frequency jet ventilation) has been shown to improve oxygenation by increasing lung volume and carbon dioxide removal by increasing tidal volume across a large spectrum of frequencies without increasing barotrauma. General anesthesia with a continuous, intravenous, short-acting agent is safe and effective during rigid bronchoscopy procedures.

There is limited knowledge on practice patterns in procedural sedation and analgesia (PSA), the use of propofol, and monitoring during flexible bronchoscopy (FB). The purpose of this study was to assess the current practice patterns of FBs and to focus on the use of propofol, the education of the proceduralist, and the involvement of anaesthesiologists during FB.

An anonymous questionnaire was sent to 299 pulmonologists. Only respondents who were active physicians in adult respiratory medicine performing FB were subsequently analysed.

The response rate was 78 % and 27,149 FB in the previous 12 months were analysed. The overall sedation-related morbidity rate was 0.02 % and mortality was 7/100’000 FB. Sedation was used in 95 % of bronchoscopies. The main drugs used for PSA were propofol (77 %) and midazolam (46 %). In 84 % of PSAs propofol was used without the attendance of an anaesthesiologist. The use of propofol was associated with high volume bronchoscopists (p < 0.010) and career-young pulmonologists (p < 0.001). While monitoring vital parameters has become standard practice, pulmonologists reported a very low rate of systematic basic education and training in the field of PSA (50 %).

In Switzerland, PSA during FB is mostly performed with propofol without the attendance of an anaesthesiologist and the use of this drug is expected to increase in the future. While monitoring standards are very high there is need for policies to improve education, systematic training, and support for pulmonologists for PSA during FB.

• Bronchoscopy
• Education
• Midazolam
• Propofol
• Sedation
• Survey

• Difficult airway patient
• Difficult airway response team
• Medical emergency teams
• Multidisciplinary
• Rapid response system
• Rapid response teams

• Rigid bronchoscopy
• ablative technologies
• central airway obstruction (CAO)
• silicone stenting

Airway complications after lung transplantation remain a significant cause of morbidity and mortality. Many of these occur at the anastomotic sites, which are susceptible due to poor collateral circulation. Of the possible complications, bronchial dehiscence is particularly formidable. These cases have been successfully treated bronchoscopically with metallic stents, which likely promote healing through granulation tissue formation. However, limited options exist in cases where the dehiscence fails to heal following stent placement. Here, we present the case report of a 65-year-old male who developed bronchial dehiscence status post bilateral lung transplantation for idiopathic pulmonary fibrosis that failed to heal with simple stent placement. Eventually, the patient underwent amniotic membrane grafting with stenting as a novel therapy for non-healing bronchial dehiscence, for which we describe the anesthetic management. His anesthetic plan included inhalational induction with sevoflurane, propofol infusion for total intravenous anesthesia, rocuronium for muscle relaxation, and closed-circuit assisted ventilation. His existing tracheostomy was used as the airway for oxygenation and induction. In summary, our anesthetic plan for the lung transplant patient was effective; future amniotic membrane grafting for bronchial dehiscence through bronchoscopy may follow a similar technique. Ultimately, the choice of anesthesia in this patient population requires judicious consideration of the requirements of the procedure as well as the pathophysiology of the transplanted lung.

• Bronchial dehiscence
• Amniotic membrane
• Grafting
• Bronchoscopy
• Lung transplantation
• Anesthesia