Interventional Pulmonology

Interventional pulmonology procedures have been moving from the office-based setting to more of a hospital-based procedure suite. This reflects the increased need for sophisticated technical equipment. In the office-based setting, bronchoscopies were performed using moderate concious sedation, however patients would require large doses of these medications to be comfortable during their procedures. This would lead to a tradeoff between grogginess and sedation for an extended period of time after the procedure or increased discomfort during the procedure.

With anesthesia, bronchoscopies are usually performed under general anesthesia, commonly with a total-intervenous anesthetic, such as an opiate/propofol combination. The breathing device used will be an laryngeal mask airway (LMA) or endotracheal tube (ETT or breathing tube). The patient will be unconcious for the duration of the procedure and awoken when the procedure is completed. Given the airway manipulation, it is not uncommon to have a sore throat for a few days (although that will go away).

The presence of the anesthesia provider allows the pulmonologist to concentrate on the procedure while allowing the anesthesia provider to ensure that the patient is breathing adequately during this procedure. This allows for more complicated procedures such as an endobronchial ultrasound (EBUS) and the ability to perform biopsies during bronchoscopy.