Anesthesiologic considerations during interventional laryngoscopy and bronchoscopy: a narrative review

Abstract

The recent and ongoing evolution towards minimally invasive procedures came with the exciting challenge for anesthesiologists to share the airway with the interventional pulmonologist or the otorhinolaryngologist. This narrative review aims to summarize the anesthesiologic considerations when preparing and performing these procedures. Medical Subject Headings (MESH) terms include 50 articles from PubMed® and Excerpta Medica Database (EMBASE) databases. Sharing the airway has led to several challenges, such as the possible loss or collapse of a safe airway. Several solutions have been found, each of which can be used in specific cases. Communication between the anesthesiologist and the interventionalist is crucial to settling on the best airway type. The literature is clear, and a thorough preprocedural assessment is needed. When surgery is performed during the apneic time, high-flow nasal oxygenation is suggested to prolong the apneic time. High- flow jet ventilation is advocated to ensure an approachable surgical field when a smaller-sized endotracheal tube is too big. Combining a flow-controlled ventilator and a small-lumen cuffed endotracheal tube can counter their possible drawbacks. A laryngeal mask is proposed in cases of high tracheal stenosis or bronchoscopic interventions. Total intravenous anesthesia is the golden standard when general anesthesia is needed, accompanied by the Bispectral Index to monitor the depth of anesthesia. The use of supplementary medication such as anticholinergics has been described and can be beneficial.