Anesthesia for bronchoscopy and interventional pulmonology: From moderate sedation to jet ventilation

PURPOSE OF REVIEW: The field of interventional bronchoscopy has seen an evolving need for different types of anesthesia for various procedures. This review describes recent advances in the field of anesthesiology that have increased the suitability of conscious sedation under monitored anesthesia care or general anesthesia for prolonged and complex interventional bronchoscopic procedures, especially those performed on severely ill patients. Additionally, the pros and cons of performing bronchoscopic procedures in the bronchoscopy suite versus the operating room are analyzed. RECENT FINDINGS: Although conscious sedation is the most commonly used form of anesthesia for simple bronchoscopic procedures, general anesthesia is emerging as a more appropriate technique for newer, more complex interventional bronchoscopic procedures. Large interventional pulmonology departments have state-of-the-art bronchoscopy suites in which both conscious sedation and general anesthesia are used. New advances in the field of anesthesiology such as the laryngeal mask airway, short-acting anesthetics with minimal effect on respiratory function, and mechanical jet ventilators are well suited for interventional bronchoscopic procedures. SUMMARY: Interventional bronchoscopists are encouraged to examine the pros and cons of different types of anesthesia for various bronchoscopic procedures.