Interventional Pulmonology

One of the unique procedures we do in our hospital is interventional pulmonology. One of our critical care pulmonologists has developed an expertise using a bronchoscope, navigational technology, and endobronchial ultrasound to biopsy and sample lesions in the lungs that otherwise could not be reached. The technology is pretty cool; he takes a CT scan of the lungs, and puts markers on the patient and bronchoscope (camera) so that as he moves the camera, the screen shows where in the CT scan he is. This allows him to be much more accurate in sampling abnormal areas than conventional bronchoscopy (since abnormalities cannot always be seen with the camera in the lungs). There are similar technologies for neurosurgery (so a surgeon minimizes trauma to normal brain tissue) and orthopedic surgery (so a computer can simulate how a joint moves).

In the past, if someone had a suspicious lung nodule or lymph nodes, they generally could only be biopsies from outside the body; an interventional radiologist would place a needle through the chest wall. If the lesions were too deep within the lungs, however, that would be too risky. Bronchoscopic techniques where the camera enters the lungs are perfect for those lesions that are deep in the body. With these techniques, we can make sure those who need surgery get it and those with benign or metastatic lesions don't.

The anesthetic requirements are tricky. A lot of these patients have significant medical problems, particularly if they have been long-time smokers and developed COPD or other lung diseases as a result. The procedure is done through a very large endotracheal tube which can make intubation more challenging. The patient is under general anesthesia and cannot move, but the procedures can be quick, so the perfect anesthetic gets them into and out of a deep plane of anesthesia briskly, which can be hard to achieve, especially if they have cardiovascular disease or renal insufficiency. The procedures are done out of the operating room (for us, in endoscopy), and that makes anesthesiologists uneasy.

The next frontier in medicine is more and more minimally invasive procedures. We have been able to do endoscopy and colonoscopy for a long time, but only recently have our technologies blossomed for bronchoscopy, beyond just looking at the airways. As other fields develop, anesthesia must keep up with accommodating these new techniques, and this is one great example of that.