Intubated or rigid bronchoscopy under high-flow oxygenation and deep sedation without ventilator or anesthesiologist: A report on a new technique

Abstract

As the demand for advanced bronchoscopic procedures increases, prolonged sedation with adequate oxygenation has become essential. Traditionally, these procedures require an anesthesiologist to provide (positive-pressure or jet) ventilator support. However, recent innovations have enabled advanced bronchoscopy under high-flow endotracheal oxygenation and deep sedation without these requirements. Following oropharyngeal lidocaine anaesthesia, deep sedation was induced using fentanyl and remimazolam. Thereafter lidocaine was instilled into the larynx, trachea, and main bronchi using a flexible bronchoscope with a spray catheter. Finally, either an uncuffed endotracheal tube (Case 1) or a rigid bronchoscope (Case 2) was inserted, and advanced bronchoscopic procedures, such as cryobiopsy and stent insertion, were successfully performed without a ventilator or an anesthesiologist. Our novel technique is expected to facilitate the easier and adequate performance of advanced high-level bronchoscopic procedures by pulmonologists, even in resource-limited settings.