5  Anesthesia for Interventional Bronchoscopic Procedures	85

with the adjustable pressure-limiting (APL) valve set at a pressure tailored to the patient’s tolerance.

––Maintain the same consistent ventilator settings throughout the procedure.

Anesthesia for Interventional Bronchoscopic Procedures During the COVID-19 Pandemic

Bronchoscopy is considered an aerosol-­ generating procedure due to the coughing encountered during the procedure and the movement of the bronchoscope in and out of the airway. In patients undergoing bronchoscopic procedures under general anesthesia, the process of intubation and extubation is also considered aerosol generating. Additionally, the use of high fow nasal cannula and noninvasive positive pressure ventilation is known to aerosolize the virus into the procedure room air [43]. It has been generally recommended to have the patient undergoing bronchoscopic procedures tested for COVID-19 within 72 h before the procedure. These recommendations are based on the perception that preprocedural testing decreases the risk to both the patient and health care providers. It is also essential to comply with full personal protective equipment’s PPE during the procedure to avoid spreading the virus outside the procedure room. Jet ventilation is believed to generate the most aerosolization, and attempts should be made to avoid it in patients testing positive for COVID19 [44].

Summary and Recommendations

Conclusion

The eld of interventional bronchoscopy has been evolving and becoming more sophisticated, as has the eld of anesthesiology. As a result, the older techniques of local anesthesia may not be as well suited for new, complex, prolonged bronchoscopic procedures. Communication between interventional bronchoscopy depart-

ments and anesthesiology departments is necessary to delineate­ when anesthesia services are needed and where certain bronchoscopic procedures should be performed. Recent advances in the eld of anesthesiology render both conscious sedation and general anesthesia for interventional bronchoscopy safe, and the use of these advances is invaluable for the continued growth of the eld of interventional bronchoscopy.

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Bronchoscopy Education: New	6
Insights

Henri G. Colt

Tell me and I’ll forget; show me and I may remember; involve me and I’ll understand. (Chinese proverb)

Background

I have always been amazed that medical education involved learning “on” patients as well as from them. Many years ago, surrounded by other medical students, I positioned myself so as to stand directly beside my senior resident as he prepared to perform a lumbar puncture. Erect in our long white coats, leaning inward with anticipatory curiosity and awe, we marveled at the way he told the patient what he was going to do before ordering her to turn onto her side. After prepping the skin, he inserted the spinal needle effortlessly. We cringed collectively, however, as it was repositioned, causing the patient to cry out in pain. We sighed with relief when a clear uid suddenly appeared, and the procedure fnished, we admired the authoritative tone with which our resident informed this small, frail, and frightened 18-year old girl with sweat-drenched hair and a poorly ftting hospital gown that uncovered her bare buttocks and lower back, that she must lay quietly for several hours and that everything was going to be fne. As we followed the resident out of the room (the ward had several patients, all of

H. G. Colt (*)

University of California, Irvine, Orange, CA, USA

whom had been watching us), we felt important in our white coats. Like a swarm of ies around a picnic table covered with food, we excitedly spoke about how cool the resident had been and how easy the procedure seemed. Later that afternoon, I recalled that we had never been told the patient’s name, nor been introduced to her as she lay passively on her bed. We were not given much of an explanation about the procedure either, and I had not yet had the opportunity to watch others before I was told the very next morning to “go tap that patient in bed 3”.

Until very recently, medical training has followed guidelines established by Flexner and Halsted in the early twentieth century [1]: A step-­ wise postgraduate training program is designed within a “see one, do one, teach one” paradigm, with patients serving as teaching material. Trainees gradually achieve independence from faculty supervision as they progress through their years of apprenticeship. Competency is often presumed based on numbers of procedures performed, and objective measures of knowledge (high-stakes tests) are used for licensure and certifcation purposes [2].

Today, “see one, do one, teach one” is no longer an acceptable paradigm of procedure-related medical instruction, so patients need no longer suffer the burden of procedure-related training. Furthermore, teachers need no longer devote hours to enumerating facts and fgures related to medical illnesses because educational media are

© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023

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J. P. Díaz-Jiménez, A. N. Rodríguez (eds.), Interventions in Pulmonary Medicine, https://doi.org/10.1007/978-3-031-22610-6_6