tion with the patient’s clinical signs can guide the titration of intravenous anesthetics to achieve adequate depth of anesthesia. Consequently, adequate sedation without undesired side effects, such as respiratory failure or cardiovascular instability associated with increased depth of anesthesia, is more likely to be attained [27].

Description of the Equipment

Needed

Interventional Bronchoscopy Suites

Interventional bronchoscopic procedures are commonly performed in an interventional bronchoscopy suite or the operating room. In most centers, the choice of the location of the procedure depends on the available resources and the anesthesia technique required. Interventional bronchoscopic procedures requiring local anesthesia and/or conscious sedation are usually performed in an interventional bronchoscopy suite where conscious sedation is administered by a trained bronchoscopy nurse under the supervision of the bronchoscopist. Meanwhile, rigid bronchoscopy or procedures that require general anesthesia are commonly performed in the operating room [28]. In recent years, interventional bronchoscopy departments that perform a large number of procedures on a daily basis have designed their interventional bronchoscopy suites in collaboration with the anesthesiologist at their practice to be a replica of an operating room. This has allowed the bronchoscopists to perform more procedures under MAC or general anesthesia in the bronchoscopy suites. Interventional bronchoscopy suites have been operational for several years with great success in several centers in the United States and Europe [29].

Airway Devices

Procedures performed under conscious sedation or MAC require no invasive airway devices. However, the patient’s oxygenation should be monitored by pulse oximetry, and supplemental oxygen should be delivered to maintain the patient’s saturation above 90% during the procedure and in the recovery area [13].

Laryngeal Mask Airway (LMA)

The LMA was rst introduced more than 20 years ago and is still used today, with a consistently low incidence of complications. The LMA is an ideal airway device for advanced bronchoscopic procedures. The large diameter of the shaft of the LMA makes it easy to insert large therapeutic bronchoscopes without compromise to the ventilation (Fig. 5.3). The LMA also allows the bronchoscopist to inspect the entire length of the airway from the vocal cords to the distal large bronchi. Additionally, the LMA allows free mobility of the bronchoscope in the airway when compared to an ETT. A bite block needs to be inserted around the LMA. Alternatively, the I-gel version of the LMA has a built-in bite block. The disadvantages of the LMA are the lack of protection against aspiration and the inability to seat the LMA in patients with oral, pharyngeal, or laryngeal deformity or pathology or those who have received radiotherapy. It is important to note that the LMA was originally designed for spontaneously ventilating patients; however, mechanical

Fig. 5.3  EBUS bronchoscope introduced through LMA