Anesthesia in Thoracic Surgery (eBook)

Contents 5
Introduction 8
Part I: Introduction 9
1: Pulmonary Resection: From Classical Approaches to Robotic Surgery 10
1.1 The Thoracic Surgery in Antiquity 10
1.2 Classical Thoracoscopy 12
1.3 Tracheal Surgery 12
1.4 Lung Transplantation 14
1.5 The Video Assisted Thoracic Surgery (VATS) 15
1.6 Robotic Surgery 17
1.6.1 Concerns and Disadvantages of VATS and Why There Is a Potential to be Replaced by RATS 19
1.6.2 Robotic Lobectomy 20
1.7 Conclusions 22
References 23
2: Preoperative Evaluation: Frailty Parameters, Preoperative Neoadjuvant Therapy—Indications for Postoperative Care Unit 26
2.1 Introduction 26
2.2 Concept of Frailty 26
2.3 How Do We Assess Frailty? 27
2.4 Frailty and Thoracic Surgery 28
2.4.1 Implications of Neoadjuvant Therapy in Preoperative Evaluation 29
2.5 Indications for Postoperative Care Unit 31
2.5.1 Postoperative Care Units: Intermediate Care vs. Intensive Care 31
2.5.1.1 Postanesthesia Care Unit (PACU) 32
2.5.1.2 Dedicated Intermediate Care/Step Down Unit (SDU) or High Dependency Unit (HDU) 32
2.5.1.3 ICU 34
2.5.2 Routine Admission to Intensive Care After Lung Resection? Risk Factors ICU Admission 35
References 37
3: Prehabilitation in Thoracic Surgery 40
3.1 Introduction 40
3.2 Nutritional Aspects 41
3.3 Education and Counselling 42
3.4 Smoking Cessation 43
3.5 Alcohol Dependency 43
3.6 Oral Hygiene 44
3.7 Psychological Support 45
3.8 Physical Fitness 45
3.8.1 Preoperative Functional Assessment (Table 3.2) 45
3.8.2 Causes of Poor Physical Fitness 47
3.8.3 Exercise-Induced Improvement in Muscular and Cardiopulmonary Function 48
3.8.3.1 Mechanisms of Exercise-Induced Improvement in Physical Fitness 48
3.8.4 Impact of Exercise Training in Thoracic Surgery 50
3.9 Conclusions 51
References 52
Part II: Airway and Ventilation Management in Thoracic Surgery 55
4: Lung Isolation Versus Lung Separation: Double-Lumen Tubes 56
4.1 Introduction 56
4.2 Indications 58
4.3 Methods for Lung Ventilation (OLV) 59
4.4 Comparative Performances and Limitations of DLTs and BBs 61
4.5 Double-Lumen Tubes: First Step—The Positioning 63
4.6 Terminating Surgery and Reintubating the Patient: Tube Exchangers 64
4.7 Conclusion 65
References 65
5: Bronchial Blockers: Applications in Thoracic Surgery 69
5.1 Introduction 69
5.2 History of Bronchial Blockers 70
5.3 Indications for Lung Isolation 71
5.4 General Indications for Bronchial Blockers (BBs) 71
5.5 Types of Bronchial Blockers 72
5.5.1 UNIVENT (Fuji Systems Corporation, Tokyo) 72
5.5.2 The Arndt Bronchial Blocker (William Cook Europe, Denmark) 73
5.5.3 The Cohen Bronchial Blocker (William Cook Europe Aps, Denmark) 75
5.5.4 Fuji Uniblocker Bronchial Blocker 76
5.5.5 EZ-Blocker Bronchial Blocker (Teleflex Life Sciences Ltd., Athlone, Ireland) (EZB) 77
References 78
6: Utility of Bronchoscope in Thoracic Surgery 80
6.1 The Flexible Bronchoscope 80
6.1.1 Flexible Bronchoscope Dimensions 81
6.1.2 Disposable Flexible Bronchoscope 81
6.1.3 Recommendations for Flexible Bronchoscopy 81
6.1.4 Anesthesiologist’s Role in Flexible Bronchoscopy 82
6.1.4.1 Anesthesia in the Bronchoscopy Cabinet 82
6.1.4.2 Diagnostic Bronchoscopy Before Thoracic Surgery 83
6.2 Therapeutic Bronchoscopy 83
6.2.1 FB, Pulmonary Emphysema and Lung Volume Reduction 84
6.2.2 Bronchial Thermoplasty for the Treatment of Refractory Asthma 85
6.2.3 FB in Percutaneous Dilatational Tracheotomy 85
6.3 Sedation and Anesthesia in the Bronchoscopy Suite 85
6.4 Bronchoscopy in the Postoperative Period of Thoracic Surgery 86
6.4.1 Atelectasis 86
6.4.2 Hemoptysis 86
6.4.3 Torsion of Lobe or Lung Segment 87
6.4.4 Bronchopleural Fistula 87
6.4.5 Bronchoscopy in the Lung Transplantation 87
References 87
7: Video Laryngoscopes in Thoracic Surgery 90
7.1 Introduction 90
7.2 Lung Separation in the Era of VLs 91
7.3 Classification of VLs 91
7.3.1 Angulated Blades VLs 91
7.3.1.1 GlideScope 91
Comparisons with Other VLs 92
Tips to Facilitate GlideScope-Guided Double-Lumen Tube Intubation 92
7.3.1.2 McGrath® Series 5 93
Comparisons with Other VLs 93
Tips to Facilitate McGrath®-Guided Double-Lumen Tube Intubation 94
7.3.1.3 C-Mac D-Blade VL 94
7.3.1.4 CEL-100 Videolaryngoscope™ 94
7.3.2 Channelled VLs 94
7.3.2.1 Airtraq 94
Comparisons with Other VLs 94
7.3.2.2 Pentax Airway Scope 95
7.3.2.3 King Vision™ 96
Comparisons with Other VLs 96
7.3.3 Video-Stylet 96
7.3.3.1 Bonfils Intubation Fiberscope 96
7.3.3.2 Clarus Video System (Trachway) Video Stylet and the OptiScope® 96
7.3.3.3 Shikani Optical Stylet 98
7.3.3.4 Lighted Stylet 98
Comparisons with Other VLs 98
7.4 Awake Endobronchial Intubation Using VLs 98
7.4.1 GlideScope 98
7.4.2 Airtraq 99
7.4.3 Clarus Video System 99
References 99
8: Intubation Guides, Tube Exchanger Catheter and Safe Extubation in Thoracic Surgery 102
8.1 Intubation Guides 102
8.1.1 Intubation Guides in Thoracic Surgery 103
8.2 Airway Exchange Catheter 103
8.2.1 Characteristics 104
8.2.2 Indications 104
8.2.3 Technics 105
8.2.4 Complications 107
8.3 Safe Extubation 107
References 110
9: Difficult Airway Management in Thoracic Surgery 113
9.1 Introduction 113
9.2 Preoperative Evaluation of the Difficult Airway 114
9.3 Difficult Airway and Lung Isolation 115
9.3.1 Securing the Airway a Must 115
9.4 Upper Airway Abnormalities and Lung Isolation 115
9.5 Use of a Flexible Fiber-Optic Bronchoscope During Awake Intubation in Difficult Airways 115
9.6 Use of Laryngeal Mask Airway and a Bronchial Blocker During Difficult Airways 117
9.7 Use of a Double-Lumen Endotracheal Tube in Patients with Difficult Airways 118
9.8 Tube Exchanger Technique for a Double-Lumen Endotracheal Tube 118
9.9 Exchange of a Double-Lumen Endotracheal Tube for a Single-Lumen Endotracheal Tube 119
9.10 Lung Isolation Techniques in Patients with Tracheostomies 121
9.11 Lung Isolation in Patients with Lower Airway Abnormalities 122
9.12 Extubation or Mechanical Ventilation After Surgery 123
9.13 Summary 124
References 124
10: Respiratory Mechanics and Gas Exchange in Thoracic Surgery: Changes in Classical Knowledge in Respiratory Physiology 127
10.1 Respiratory Mechanics 127
10.1.1 Plateau, Peak Inspiratory Pressure and Transpulmonary Pressure 128
10.1.2 Positive End-Expiratory Pressure and Recruitment Maneuvers 128
10.1.3 Auto-PEEP 129
10.1.4 Driving Pressure 130
10.1.5 Tidal Volume 130
10.1.6 Compliance and Functional Residual Capacity 130
10.1.7 Inspiratory to Expiratory Time Ratio 131
10.1.8 Stress and Strain 132
10.2 Gas Exchange 132
10.3 Ventilation-Perfusion-Matching 133
10.4 Ventilation 133
10.5 Perfusion 134
10.6 Considerations for Non-tubed Procedures 135
References 135
11: Non-intubated Video-Assisted Surgery: A Critical Review 139
11.1 Introduction 139
11.2 History of Non-intubated Thoracoscopy 140
11.3 Pathophysiology of Breathing with an Open Pneumothorax 141
11.3.1 Decrease in Lung Volumes and Lung Function 141
11.3.2 Hemodynamic Changes of an Open Pneumothorax with Breathing 143
11.4 Patient Selection for Non-intubated Video-Assisted Thoracic Surgery 143
11.4.1 Indications 143
11.4.2 Contraindications to Non-intubated VATS (Table 11.1) 144
11.5 Anesthesia for Non-intubated Video-Assisted Thoracic Surgery 145
11.5.1 Regional Anesthesia 146
11.5.2 Sedation for NI-VATS 146
11.5.3 Airway and Oxygenation During NI-VATS 147
11.5.4 Monitoring During NI-VATS 147
11.6 Benefits of NI-VATS 148
11.7 Safety of NI-VATS 150
11.8 Conclusions 151
References 152
12: Changes in Ventilation Strategies During Thoracic Surgery: Do We Have to Focus “Only” in Oxygenation? 155
12.1 Introduction 155
12.2 “Protective Ventilation” 157
12.2.1 Tidal Volume (VT) 158
12.2.2 Lung Recruitment Manoeuvres 158
12.2.3 Positive End-Expiratory Pressure (PEEP) 160
12.3 Ventilatory Modes 160
12.4 CPAP to the Nondependent Lung 161
12.5 Inhalational vs IV Anaesthetics 162
12.6 Conclusion 162
References 162
Part III: Perioperative Medicine: Analgesia, Applied Pharmacology, Hemodynamic Control and Infections 167
13: Change in “Gold Standard” of Thoracic Epidural in Thoracic Surgery 168
13.1 Introduction 168
13.2 Thoracic Surgery: From Thoracotomy to Video-Assisted Thoracoscopic and Robotic Surgery—Toward Minimally Invasive Procedures—Fast-Track Surgery and Eras 169
13.3 Thoracic Surgery and Analgesia: Together into the Future 170
13.3.1 Thoracic Epidural Analgesia 171
13.3.2 Intercostal Nerve Block 172
13.3.3 Interpleural Nerve Block 173
13.3.4 Paravertebral Nerve Block 173
13.3.5 Fascial Blocks on the Thoracic Wall 175
13.4 Gold Standard in Thoracic Surgery 177
References 181
14: Are There New Evidences on the Use of Neuromuscular Blocking Agents and Reversal Drugs in Thoracic Surgery? 184
14.1 Introduction 184
14.2 Aspects of Interest for the Clinician About the Neurobiology of the Neuromuscular Junction 185
14.3 Some Considerations on NMBA Pharmacology 186
14.4 Characteristics of Patients Under Oncologic Thoracic Surgery Related to Muscle Function 189
14.5 Muscle Relaxation Requirements During Thoracic and Esophageal Surgical Procedures 191
14.6 Recovery from Neuromuscular Blockade After Thoracic Surgery 193
14.7 Day Case Thoracic Surgical Procedures 196
14.8 Thoracic Procedures in Patients with Neuromuscular Diseases and Rare Diseases 198
14.9 Neuromuscular Blockade and Invasive Bronchology (Bronchoscopy and Echobronchoscopy-EBUS) 200
14.10 Postoperative Pulmonary Complications: The Role of (Neglected) Residual Neuromuscular Blockade 201
14.11 Conclusions 202
References 203
15: Are Anticoagulants and Antiplatelet Agents Important in Thoracic Surgery? 208
15.1 Are Anticoagulants and Antiplatelet Agents Important in Thoracic Surgery? 208
15.2 Is It Important the Bleeding and Thrombotic Risk Assessment? 209
15.2.1 Bleeding Risk in Thoracic Surgery 209
15.2.2 Thrombotic Risk 210
15.3 How to Manage Anticoagulation in Patients Scheduled for Thoracic Surgery? 211
15.3.1 Is It Necessary to Withdraw the Anticoagulant? 211
15.3.1.1 Vitamin K Antagonists 211
15.3.1.2 Direct Oral Anticoagulants 211
15.3.2 What About Anticoagulation After Surgery? 213
15.4 How to Manage Antiplatelet Drugs in Patients Scheduled for Thoracic Surgery? 213
15.4.1 Which Are Main Recommendations for Patients Scheduled for Thoracic Surgery? 214
15.4.1.1 Aspirin 214
15.4.2 Clopidogrel and Prasugrel 215
15.5 Is It Suitable the Thromboprophylaxis in Thoracic Surgery? 215
15.5.1 Which Methods for Thromboprophylaxis Are Available? 215
15.5.2 Rationale for Thromboprophylaxis in Thoracic Surgery 216
15.5.3 Which Recommendations for Thromboprophylaxis in Thoracic Surgery? 216
15.5.4 Thromboprophylaxis in the Perioperative Period: Implications for the Anaesthesiologist 218
References 218
16: Prevention and Treatment of Infections 221
16.1 Introduction 221
16.2 Surgical Site Infections 222
16.3 Prevention of Surgical Site Infections on Thoracic Surgery 223
16.3.1 CDC: OMS Recommendations 223
16.3.2 Multimodal Strategy in Thoracic Surgery: Enhanced Recovery Thoracic Surgery 224
16.4 Antibiotic Prophylaxis in Thoracic surgery 224
16.5 Early Infection Diagnosis 226
16.5.1 Rapid Microbiological Diagnostic Tests 227
16.5.2 Exhaled Breath Biomarkers 228
16.5.3 Blood Biomarkers 228
16.5.4 Immune Dysregulation 230
16.5.5 Endothelium and Infection 231
16.6 Nosocomial Infection 232
16.6.1 Pneumonia 232
16.6.1.1 Non-antibiotic Treatment of Infection 235
16.6.2 Empyema 236
16.6.3 Mediastinitis 237
References 238
17: The Role of Ultrasound (US) in Thoracic Surgery 244
17.1 Introduction 244
17.2 Echocardiography in Thoracic Surgery and Chest Trauma 244
17.3 Perioperative Lung Ultrasound (PoLUS) 247
17.3.1 Equipment 247
17.3.2 Recommended Scanning Regions (Fig. 17.2) 247
17.3.3 Terminology: The Lung Ultrasound Alphabet 248
17.3.3.1 BAT-Sign with Identification of the Pleural Line (Fig. 17.3) 248
17.3.3.2 A-lines 249
17.3.3.3 Lung Sliding and Lung Pulse 249
17.3.3.4 M-Mode Signs: The Seashore, Stratosphere Sign and T-Lines (Fig. 17.4) 249
17.3.3.5 The Lung Point 250
17.3.3.6 B-Lines and Lung Rockets 251
17.3.3.7 The Tissue-Like Sign 251
17.3.3.8 Pleural Fluid 251
17.3.4 Clinical Applications 252
17.3.4.1 One-Lung Ventilation and Airway Instrumentation 252
17.3.4.2 Pneumothorax 253
17.3.4.3 Fluid Administration/Lung Edema 253
17.3.4.4 Atelectasis/Lung Expansion 253
17.3.4.5 Pleural Fluid and Thoracentesis 254
17.3.4.6 Diaphragmatic Function 254
17.4 Conclusion 255
References 255
18: Changes in Classical Monitoring: Hemodynamic Monitoring, New Devices, NIRS, etc. 258
18.1 Hemodynamic Monitoring 258
18.1.1 Invasive Monitoring 259
18.1.1.1 Pulmonary Artery Catheter 259
18.1.1.2 Transpulmonary Thermodilution Methods 259
18.1.2 Minimally Invasive Monitoring 261
18.1.2.1 Non-invasive Monitoring: Bioimpedance and Bioreactance 261
18.1.2.2 Applied Fick’s Principles: Partial CO2 Rebreathing (NICO® System) 262
18.1.2.3 Doppler Techniques 263
18.2 Near-Infrared Spectroscopy (NIRS) 263
18.2.1 NIRS History 263
18.2.2 Principle and Limitations of NIRS 264
18.2.3 Cerebral Autoregulation and NIRS 266
18.2.4 In Assessing Tissue Perfusion with NIRS and Changes in the Presence of Comorbidities 266
18.2.5 Assessment of Anemia-Transfusion Threshold, Cardiac Output, Oxygenation 268
18.2.6 One-Lung Ventilation and NIRS 269
References 270
Part IV: Specific Surgical Situations 274
19: Lung Transplantation: Justification for a Paradigm Change 275
19.1 Introduction 275
19.2 Lung Transplant Anaesthesia Mission 276
19.2.1 Preoperative Paradigms 276
19.2.2 Donor Management Paradigms and Ex Vivo Lung Perfusion 277
19.2.3 Intra and Postoperative Paradigms 278
19.3 Ex Vivo Lung Perfusion (EVLP) 279
19.4 Intraoperative Management Strategies to Prevent PGD and Nonpulmonary Complications 280
19.4.1 Trend Away from Clamshell Towards Minimally Invasive LTx (MILT) 281
19.4.2 Role of Cardiopulmonary Bypass (CPB) 282
19.4.3 Management of Pulmonary Hypertension 282
19.4.4 Controlled Reperfusion 284
19.4.5 Hyperoxia and Oxygen Toxicity 284
19.4.6 Antioxidant Treatment 285
19.4.7 Intravenous Fluid Therapy 285
19.5 Protective Ventilation 286
19.6 Novel Mechanisms of Lung Injury: Monocytes and Cytokines 288
References 289
20: Extracorporeal Life Support (ECMO) in Thoracic Surgery 296
20.1 Introduction 296
20.2 Configuration 298
20.2.1 VV ECMO 298
20.2.2 VA ECMO 298
20.3 Cannulation 298
20.3.1 VV ECMO 298
20.3.1.1 Two Cannula VV ECMO 298
20.3.1.2 Single Cannula VV ECMO 299
20.3.2 VA ECMO 299
20.3.2.1 Central Cannulation (Sternotomy) 299
20.3.2.2 Peripheral Cannulation 299
20.4 ECMO in Thoracic Surgery 300
20.4.1 Airway Surgery 300
20.4.2 Difficult or Impossible One Lung Ventilation (OLV) 300
20.4.3 Mediastinal Masses 301
20.4.4 Advanced Surgical Resections 301
20.4.5 Thoracic Emergencies 301
20.4.6 Lung Transplantation (LTx) 301
20.4.6.1 Bridge to Ltx 301
20.4.6.2 Intraoperative support 302
20.4.6.3 Postoperative Period 303
20.4.7 Acute Respiratory Distress Syndrome (ARDS) 303
20.5 Management 304
20.5.1 Monitoring 304
20.5.2 Anticoagulation 304
20.5.3 Ventilation 305
20.5.4 Hemodynamic 305
20.5.5 Other Monitoring 305
20.5.6 Weaning 305
20.6 Complications 305
20.7 Conclusions 306
References 306
21: Thoracic Surgery in Patients with Previous Lung Resection 309
21.1 Introduction 309
21.2 Respiratory Mechanics After Lung Resection 310
21.3 Airway Anatomy Changes After Lung Resection 312
21.4 Lung Isolation/Separation in Patients with Previous Lung Resections 313
21.5 Perioperative Mechanical Ventilation in Patients with Previous Lung Resections 314
21.6 Hemodynamic Changes After Lung Resection and Perioperative Hemodynamic Management 317
21.7 Conclusions 318
References 318
22: Anesthesia for Esophageal Surgery 322
22.1 Conceptual Hypothesis 322
22.2 Types of Esophagectomy 323
22.2.1 Traditional Approaches 323
22.2.2 New Approaches 323
22.3 Preoperative Preparation and Patient Selection for Minimally Invasive and Robotic Esophagectomy 325
22.4 Anesthesia for Minimal Invasive and Robotic Esophagectomy 326
22.4.1 Induction, Maintenance, Ventilation 326
22.4.2 Fluid Management 329
22.4.3 Blood Administration 330
22.4.4 Analgesia 331
22.5 Postoperative Care After Esophagectomy: Enhanced Recovery After Esophagectomy 331
22.5.1 Timing of Extubation and Supplemental Oxygen Therapy 332
22.5.2 Deep Vein Thrombosis Prophylaxis 332
22.5.3 Management of Drainage Tubes 333
22.5.4 Physiotherapy 333
22.5.5 Pain Management 334
22.6 Conclusions 334
References 335
23: Tracheal and Bronchial Surgery: HJFV 338
23.1 Introduction 339
23.2 Etiology: Post-tracheostomy Tracheal Stenoses Are on the Rise 339
23.3 Does the Surgery of the Large Airways Require Special Equipment? 339
23.4 General Anesthesia: Always Necessary? 340
23.5 Prepping the Patient for Anesthesia: What Information Do We Need? 341
23.6 The Anesthetic Technique Varies by Lesion Site: Optimizing the Anesthetic Steps with the Surgical Moments 343
23.6.1 Upper Tracheal Stenosis (Non-critical Subglottic) 344
23.6.2 Median Tracheal Stenosis 346
23.6.3 The Distal Trachea (Minus the Carina) is Resected Following the Same Ventilation and Surgical Rules Like in the Case of the Other Tracheo-tracheal Anastomosis 347
23.6.4 Carinal Resections with or Without Lung Resection 347
23.6.5 Esotracheal and Esobronchial Fistulas 349
23.6.6 Stenosis of the Large Bronchi: Bronchial Sleeve Resection 350
23.7 Recovery from Anesthesia 350
23.8 High Frequency Jet Ventilation (HFJV) 351
23.9 Conclusions 352
References 352
24: Pediatric Thoracic Anesthesia 356
24.1 Introduction 356
24.2 Pediatric Anatomy and Physiology 356
24.2.1 Effects of the Lateral Decubitus Position and One Lung Ventilation (OLV) in Children 357
24.3 Preoperative Evaluation 358
24.4 Anesthetic Techniques 358
24.4.1 Flexible Bronchoscopy 358
24.4.2 Rigid Bronchoscopy (RB) 359
24.4.3 Thoracic Surgery 359
24.4.3.1 Preoperative Period 359
24.4.3.2 Intraoperative Period 360
24.4.3.3 Ventilation Techniques 360
24.4.3.4 Sternotomy 362
24.4.3.5 Two Lung Ventilation with Manual Retraction 363
24.4.3.6 Lung Isolation and OLV 363
Selective Bronchial Intubation 364
Bronchial Blocker 365
Univent Tube 367
Double Lumen Tube 367
Hypoxemia Management During OLV 368
24.4.3.7 Monitoring 368
24.4.3.8 Pain Management 368
Regional Modalities 369
Intravenous Modalities 370
24.5 Conclusion 371
References 371
25: Robot-Assisted Thoracic Surgery and Anesthesia 374
25.1 Introduction 374
25.2 Surgical Point of View for Thoracic Robotic Surgery 375
25.2.1 Advantages, Disadvantages, Learning Curves 375
25.2.2 The Robot Assisted Lobectomy 377
25.2.3 The Robot Assisted Segmentectomy 377
25.2.4 The Robot Assisted Thymectomy 378
25.2.5 Summary of Surgical Point of View 379
25.3 Anesthetic Management of RATS 379
25.3.1 Are There Any Differences? 379
25.3.2 Understanding the Surgical Technique and Equipment and Patient Selection 379
25.3.3 Access to the Patient 380
25.3.4 Positioning of the Patient 380
25.3.5 Intraoperative Monitoring, CO2 Insufflation, Fluids 381
25.3.6 Communication 381
25.3.7 Lung Separation Techniques 382
25.3.8 Pain Management 382
25.3.9 Responsibility and Ethical Considerations 383
25.4 Conclusions 384
References 384
26: Interventional Bronchology 386
26.1 Introduction 386
26.2 Rigid Bronchoscopy 387
26.2.1 Introduction 387
26.2.2 Indications 389
26.2.3 Contraindications 389
26.3 Endoscopic Pneumological Techniques Using Anesthesia 390
26.3.1 Introduction 390
26.3.2 EBUS 390
26.3.3 Endobronchial Laser Surgery 391
26.3.4 Endobronchial Electrosurgery: Coagulation Using Argon Plasma 392
26.3.5 Cryotherapy 393
26.3.6 Cryobiopsy 393
26.3.7 Placement of Endobronchial Prostheses 395
26.3.8 Volume Reduction Techniques and the Treatment of Air Leaks 395
26.3.9 Endoscopic Treatment of Asthma: Bronchial Thermoplasty 397
26.4 Bronchoscopy and Anesthesia 398
26.4.1 Monitoring Anaesthesia in Interventional Bronchology 398
26.4.2 Preoperative Evaluation 398
26.4.3 Monitoring Anaesthesia in Bronchology 398
26.5 Approaches to Anaesthesia with a Rigid Bronchoscope 399
26.6 Ventilation Using Rigid Bronchoscopy 399
26.7 Approaches to Anaesthesia with a Flexible Bronchoscope 401
References 403
Correction to: Tracheal and Bronchial Surgery: HJFV 405