Prompt

Describe your anaesthetic management for rigid bronchoscopy and laser debulking of a mid-tracheal tumour, including ventilation strategy and airway fire prevention.

Model answer

Setup (3). Shared airway briefing; laser checklist (fire-safe FiO2 at or under 0.3, no N2O); tooth guard; TIVA; crossmatch if needed.

^[4] ^[5] ^[6]

Conduct (6). Deep anaesthesia ± relaxant; ventilating bronchoscope/jet/intermittent apnoea with patent egress (all severe jet events were outflow-obstruction barotrauma); lowest safe FiO2; no N2O; wet packs; laser-safe equipment; weight-based lidocaine totals titrated slowly.

^[4] ^[6] ^[7] ^[9]

Crises (6). Fire drill (advisory scope); hypoxaemia backup airway (DAS + OLV principles); bleeding isolation plan (mortality over 50%); postop oedema observation.

^[1] ^[3] ^[5] ^[8]

References9Show

[1]Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth, 2015.PMID 26556848
[2]Brassard CL, Lohser J, Donati F, Bussières JS. Step-by-step clinical management of one-lung ventilation: continuing professional development. Can J Anaesth, 2014.PMID 25389025
[3]Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation: prediction, prevention, and treatment. Anesthesiology, 2009.PMID 19417615
[4]Pathak V, Welsby I, Mahmood K, et al. Ventilation and anesthetic approaches for rigid bronchoscopy. Ann Am Thorac Soc, 2014.PMID 24635585
[5]Apfelbaum JL, Caplan RA, Barker SJ, et al. ASA practice advisory for prevention and management of operating room fires. Anesthesiology, 2013.PMID 23287706
[6]Abu-Ghanem S, Cochran J. The Use of Oxygen/Air Blender during Transoral Laser Microsurgery with Supraglottic Manual Jet Ventilation: A Safe Approach. Case Rep Anesthesiol, 2023.PMID 37701679
[7]Jaquet Y, Monnier P, Van Melle G, et al. Complications of ventilation strategies in endoscopic laryngeal surgery: 10-year review. Anesthesiology, 2006.PMID 16394690
[8]Toh TW, Goh JHF, Lie SA, et al. Clinical Approach to Massive Hemoptysis: Perioperative Focus on Causes and Management. J Cardiothorac Vasc Anesth, 2024.PMID 38964992
[9]Wu FL, Razzaghi A, Souney PF. Seizure after lidocaine for bronchoscopy: case report and review of the use of lidocaine in airway anesthesia. Pharmacotherapy, 1993.PMID 8437971

Model answer

Setup (3). Shared airway briefing; laser checklist (fire-safe FiO2 at or under 0.3, no N2O); tooth guard; TIVA; crossmatch if needed.

Crises (6). Fire drill (advisory scope); hypoxaemia backup airway (DAS + OLV principles); bleeding isolation plan (mortality over 50%); postop oedema observation.

References9Show

[1]Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth, 2015.PMID 26556848
[2]Brassard CL, Lohser J, Donati F, Bussières JS. Step-by-step clinical management of one-lung ventilation: continuing professional development. Can J Anaesth, 2014.PMID 25389025
[3]Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation: prediction, prevention, and treatment. Anesthesiology, 2009.PMID 19417615
[4]Pathak V, Welsby I, Mahmood K, et al. Ventilation and anesthetic approaches for rigid bronchoscopy. Ann Am Thorac Soc, 2014.PMID 24635585
[5]Apfelbaum JL, Caplan RA, Barker SJ, et al. ASA practice advisory for prevention and management of operating room fires. Anesthesiology, 2013.PMID 23287706
[6]Abu-Ghanem S, Cochran J. The Use of Oxygen/Air Blender during Transoral Laser Microsurgery with Supraglottic Manual Jet Ventilation: A Safe Approach. Case Rep Anesthesiol, 2023.PMID 37701679
[7]Jaquet Y, Monnier P, Van Melle G, et al. Complications of ventilation strategies in endoscopic laryngeal surgery: 10-year review. Anesthesiology, 2006.PMID 16394690
[8]Toh TW, Goh JHF, Lie SA, et al. Clinical Approach to Massive Hemoptysis: Perioperative Focus on Causes and Management. J Cardiothorac Vasc Anesth, 2024.PMID 38964992
[9]Wu FL, Razzaghi A, Souney PF. Seizure after lidocaine for bronchoscopy: case report and review of the use of lidocaine in airway anesthesia. Pharmacotherapy, 1993.PMID 8437971

Anaesthesia for bronchoscopy and shared airway surgery

Model answer

Anaesthesia for bronchoscopy and shared airway surgery

Model answer