Laser bronchoscopy can be challenging to the anesthesiologist and the endoscopist.52 The anesthetic method used depends on the type of bronchoscopic technique. Most of the patients are high-risk, with concomitant chronic obstructive pulmonary disease and cardiovascular disease. In these patients, topical anesthesia offers the possibility of avoiding potential complications of general anesthesia, such as arrhythmia, myocardial infarction, CO2 retention, neuromuscular weakness, and hemodynamic instability. In these cases, topical lidocaine combined with intravenous sedation/anesthesia and assisted ventilation are used. With this topical technique used in high-risk patients, the control of cough is often difficult when working near the carina. If possible, complete control of the airway with relaxation techniques and Venturi jet ventilation is desired, allowing use of the open bronchoscope for rapid application of the laser and removal of obstructing tumor figure 37-5 Early application of laser technology in the trachea. Treatment of peristomal papillomas with the CO2 laser.
figure 37-5 Early application of laser technology in the trachea. Treatment of peristomal papillomas with the CO2 laser.
particles, blood, and secretions. Pulse oximetry is recommended to monitor for desaturation. The mean operating time is approximately 30 to 40 minutes and the procedure is usually well tolerated.
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