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EDITORIAL
Year : 2020  |  Volume : 3  |  Issue : 3  |  Page : 119

Total intravenous anaesthesia for pulmonary interventions


Department of Respiratory Medicine, Apollo Main Hospital, Chennai, Tamil Nadu, India

Date of Submission08-Mar-2021
Date of Acceptance08-Mar-2021
Date of Web Publication28-Apr-2021

Correspondence Address:
R Narasimhan
Department of Respiratory Medicine, Apollo Main Hospital, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/japt.japt_8_21

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How to cite this article:
Narasimhan R. Total intravenous anaesthesia for pulmonary interventions. J Assoc Pulmonologist Tamilnadu 2020;3:119

How to cite this URL:
Narasimhan R. Total intravenous anaesthesia for pulmonary interventions. J Assoc Pulmonologist Tamilnadu [serial online] 2020 [cited 2021 Sep 20];3:119. Available from: http://www.japt.com/text.asp?2020/3/3/119/314971



Pulmonary interventions such as bronchoscopy, thoracoscopy, medical thoracoscopy, cryobiopsy, EBUS, foreign body removal, and stenting are becoming common, and many young pulmonologists are keen on getting into this exciting field. Gone are the days when people were afraid of doing the bronchoscopy or think of referring to a surgeon. Many pulmonoligists feel that they can do most of them themselves and are successful at it too.

If one analyzes the reason behind the reluctance, he/she would learn that making the patient comfortable during interventions was a challenge. Many physicians are under the impression that interventions should be the last resort in patients who are breathless and those with heart ailments or other comorbidities. This is a wrong thought as many precious days would have been lost if one thinks of interventions as the last resort. Some of us who started flexible bronchoscope have faced the problem of convincing both the physician and the patient as it used to be done under xylocaine anesthesia or general anesthesia.

The use of intratracheal xylocaine was a great boon to many pulmonologists. This combined with intravenous sedatives in low doses used to make the patient accept the procedure. Still, the patient would refuse to come for a repeat bronchoscopy as retrograde amnesia is not a characteristic of these drugs. The advent of propofol and its use in interventions has made tremendous progress in interventional pulmonology. Benzodiazepines also are used in bronchoscopy for their sedative effect. Opioids such as fentanyl are used for their antitussive, analgesic, and sedative effects. However, no drug can come close to propofol as it is a short-acting drug with moderate sedative effect. It has a rapid onset of action and recovery. Once the infusion is stopped, patient is awake. It is used extensively by pulmonologists for its antipruritic, hypnotic, and antiemetic effects. It attenuates upper airway reflexes too. It can be used as bolus or as intravenous infusion when the procedure is prolonged like Endobronchial ultrasound (EBUS) or stenting. It can cause respiratory depression because the therapeutic window between safe sedative and anesthetic dose is narrow. Hence, there has to be an anesthetist for propofol. Fospropofol, a prodrug, is also used because of its property of less pain at the site of injection and shorter elimination half-life. Both propofol and fospropofol have the greatest advantage of retrograde amnesia, so the patient is willing for repeat bronchoscopy.

The use of propofol group of drugs in injectable forms to achieve safe sedative and anesthetic effect in pulmonary interventions is called total intravenous anesthesia (TIVA). This is cathing up so fast that most of us would be switching over to TIVA for interventions rather than local anesthesia as the benefits of TIVA for pulmonary interventions outweigh the use of local anesthesia for bronchoscopies. After all the physician and patient comfort is very important in any endoscopic interventions and TIVA fits the bill well.






 

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