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Anesthetic considerations for interventional pulmonary procedures

机译：介入性肺手术的麻醉注意事项

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PURPOSE OF REVIEW: To discuss the anesthetic considerations of various procedures now performed by the interventional pulmonologist. With recent technological advances, many of these procedures represent acceptable alternatives to the invasive surgical procedures. For example, the placement of endobronchial valves can substitute for lung reduction surgery and can greatly reduce the postoperative recovery period. However, many of these complex procedures require anesthesia services. The nature and indication for the procedure as well as the patient's overall health will have an impact on the anesthetic choice. RECENT FINDINGS: New studies have documented common complications from interventional pulmonology procedures and recent ways to avoid these complications have been suggested. Strategies to avoid obstruction, bleeding, pneumothorax and air embolism are discussed in this article. Potential benefits of high frequency jet ventilation in reducing airway pressures and, perhaps, barotraumas are cited. Novel interventional pulmonary procedures are described. SUMMARY: As the array of diagnostic and therapeutic pulmonary interventions is expanding, the types of anesthetic techniques and ventilatory modes are varying to fit the procedural requirements. Some pulmonary procedures are best accomplished in the lightly sedated patient, who is breathing spontaneously, whereas procedures that use the working channel of a rigid bronchoscope are better performed in the patient under general anesthesia and mechanical ventilation that often use jet ventilation to minimize respiratory movements.
机译：审查的目的：讨论目前由介入肺科医生进行的各种手术的麻醉注意事项。随着最新技术的进步，这些程序中的许多代表了侵入性外科程序的可接受的替代方案。例如，放置支气管内瓣膜可以代替减少肺部手术，并可以大大缩短术后恢复期。但是，这些复杂的程序中有许多都需要麻醉服务。手术的性质和适应症以及患者的整体健康状况将对麻醉剂的选择产生影响。最近的发现：新的研究已经记录了介入肺科手术的常见并发症，并提出了避免这些并发症的最新方法。本文讨论了避免阻塞，出血，气胸和空气栓塞的策略。高频射流通气在降低气道压力和气压伤中的潜在益处。描述了新型的介入性肺手术。简介：随着诊断性和治疗性肺部干预的范围不断扩大，麻醉技术和通气模式的类型也不断变化，以适应手术要求。有些肺部手术最好在自发呼吸的轻度镇静患者中完成，而在全身麻醉和机械通气（通常使用喷射通气以尽量减少呼吸运动）的情况下，使用刚性支气管镜工作通道的手术最好在患者中进行。

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