Anesthesia in Thoracic Surgery: Changes of Paradigms

Contents
Introduction
Part I: Introduction
	1: Pulmonary Resection: From Classical Approaches to Robotic Surgery
		1.1	 The Thoracic Surgery in Antiquity
		1.2	 Classical Thoracoscopy
		1.3	 Tracheal Surgery
		1.4	 Lung Transplantation
		1.5	 The Video Assisted Thoracic Surgery (VATS)
		1.6	 Robotic Surgery
			1.6.1	 Concerns and Disadvantages of VATS and Why There Is a Potential to be Replaced by RATS
			1.6.2	 Robotic Lobectomy
		1.7	 Conclusions
		References
	2: Preoperative Evaluation: Frailty Parameters, Preoperative Neoadjuvant Therapy—Indications for Postoperative Care Unit
		2.1	 Introduction
		2.2	 Concept of Frailty
		2.3	 How Do We Assess Frailty?
		2.4	 Frailty and Thoracic Surgery
			2.4.1	 Implications of Neoadjuvant Therapy in Preoperative Evaluation
		2.5	 Indications for Postoperative Care Unit
			2.5.1	 Postoperative Care Units: Intermediate Care vs. Intensive Care
				2.5.1.1	 Postanesthesia Care Unit (PACU)
				2.5.1.2	 Dedicated Intermediate Care/Step Down Unit (SDU) or High Dependency Unit (HDU)
				2.5.1.3	 ICU
			2.5.2	 Routine Admission to Intensive Care After Lung Resection? Risk Factors ICU Admission
		References
	3: Prehabilitation in Thoracic Surgery
		3.1	 Introduction
		3.2	 Nutritional Aspects
		3.3	 Education and Counselling
		3.4	 Smoking Cessation
		3.5	 Alcohol Dependency
		3.6	 Oral Hygiene
		3.7	 Psychological Support
		3.8	 Physical Fitness
			3.8.1	 Preoperative Functional Assessment (Table 3.2)
			3.8.2	 Causes of Poor Physical Fitness
			3.8.3	 Exercise-Induced Improvement in Muscular and Cardiopulmonary Function
				3.8.3.1	 Mechanisms of Exercise-Induced Improvement in Physical Fitness
			3.8.4	 Impact of Exercise Training in Thoracic Surgery
		3.9	 Conclusions
		References
Part II: Airway and Ventilation Management in Thoracic Surgery
	4: Lung Isolation Versus Lung Separation: Double-Lumen Tubes
		4.1	 Introduction
		4.2	 Indications
		4.3	 Methods for Lung Ventilation (OLV)
		4.4	 Comparative Performances and Limitations of DLTs and BBs
		4.5	 Double-Lumen Tubes: First Step—The Positioning
		4.6	 Terminating Surgery and Reintubating the Patient: Tube Exchangers
		4.7	 Conclusion
		References
	5: Bronchial Blockers: Applications in Thoracic Surgery
		5.1	 Introduction
		5.2	 History of Bronchial Blockers
		5.3	 Indications for Lung Isolation
		5.4	 General Indications for Bronchial Blockers (BBs)
		5.5	 Types of Bronchial Blockers
			5.5.1	 UNIVENT (Fuji Systems Corporation, Tokyo)
			5.5.2	 The Arndt Bronchial Blocker (William Cook Europe, Denmark)
			5.5.3	 The Cohen Bronchial Blocker (William Cook Europe Aps, Denmark)
			5.5.4	 Fuji Uniblocker Bronchial Blocker
			5.5.5	 EZ-Blocker Bronchial Blocker (Teleflex Life Sciences Ltd., Athlone, Ireland) (EZB)
		References
	6: Utility of Bronchoscope in Thoracic Surgery
		6.1	 The Flexible Bronchoscope
			6.1.1	 Flexible Bronchoscope Dimensions
			6.1.2	 Disposable Flexible Bronchoscope
			6.1.3	 Recommendations for Flexible Bronchoscopy
			6.1.4	 Anesthesiologist’s Role in Flexible Bronchoscopy
				6.1.4.1	 Anesthesia in the Bronchoscopy Cabinet
				6.1.4.2	 Diagnostic Bronchoscopy Before Thoracic Surgery
		6.2	 Therapeutic Bronchoscopy
			6.2.1	 FB, Pulmonary Emphysema and Lung Volume Reduction
			6.2.2	 Bronchial Thermoplasty for the Treatment of Refractory Asthma
			6.2.3	 FB in Percutaneous Dilatational Tracheotomy
		6.3	 Sedation and Anesthesia in the Bronchoscopy Suite
		6.4	 Bronchoscopy in the Postoperative Period of Thoracic Surgery
			6.4.1	 Atelectasis
			6.4.2	 Hemoptysis
			6.4.3	 Torsion of Lobe or Lung Segment
			6.4.4	 Bronchopleural Fistula
			6.4.5	 Bronchoscopy in the Lung Transplantation
		References
	7: Video Laryngoscopes in Thoracic Surgery
		7.1	 Introduction
		7.2	 Lung Separation in the Era of VLs
		7.3	 Classification of VLs
			7.3.1	 Angulated Blades VLs
				7.3.1.1	 GlideScope
					Comparisons with Other VLs
					Tips to Facilitate GlideScope-Guided Double-Lumen Tube Intubation
				7.3.1.2	 McGrath® Series 5
					Comparisons with Other VLs
					Tips to Facilitate McGrath®-Guided Double-Lumen Tube Intubation
				7.3.1.3	 C-Mac D-Blade VL
				7.3.1.4	 CEL-100 Videolaryngoscope™
			7.3.2	 Channelled VLs
				7.3.2.1	 Airtraq
					Comparisons with Other VLs
				7.3.2.2	 Pentax Airway Scope
				7.3.2.3	 King Vision™
					Comparisons with Other VLs
			7.3.3	 Video-Stylet
				7.3.3.1	 Bonfils Intubation Fiberscope
				7.3.3.2	 Clarus Video System (Trachway) Video Stylet and the OptiScope®
				7.3.3.3	 Shikani Optical Stylet
				7.3.3.4	 Lighted Stylet
					Comparisons with Other VLs
		7.4	 Awake Endobronchial Intubation Using VLs
			7.4.1	 GlideScope
			7.4.2	 Airtraq
			7.4.3	 Clarus Video System
		References
	8: Intubation Guides, Tube Exchanger Catheter and Safe Extubation in Thoracic Surgery
		8.1	 Intubation Guides
			8.1.1	 Intubation Guides in Thoracic Surgery
		8.2	 Airway Exchange Catheter
			8.2.1	 Characteristics
			8.2.2	 Indications
			8.2.3	 Technics
			8.2.4	 Complications
		8.3	 Safe Extubation
		References
	9: Difficult Airway Management in Thoracic Surgery
		9.1	 Introduction
		9.2	 Preoperative Evaluation of the Difficult Airway
		9.3	 Difficult Airway and Lung Isolation
			9.3.1	 Securing the Airway a Must
		9.4	 Upper Airway Abnormalities and Lung Isolation
		9.5	 Use of a Flexible Fiber-Optic Bronchoscope During Awake Intubation in Difficult Airways
		9.6	 Use of Laryngeal Mask Airway and a Bronchial Blocker During Difficult Airways
		9.7	 Use of a Double-Lumen Endotracheal Tube in Patients with Difficult Airways
		9.8	 Tube Exchanger Technique for a Double-Lumen Endotracheal Tube
		9.9	 Exchange of a Double-Lumen Endotracheal Tube for a Single-Lumen Endotracheal Tube
		9.10	 Lung Isolation Techniques in Patients with Tracheostomies
		9.11	 Lung Isolation in Patients with Lower Airway Abnormalities
		9.12	 Extubation or Mechanical Ventilation After Surgery
		9.13	 Summary
		References
	10: Respiratory Mechanics and Gas Exchange in Thoracic Surgery: Changes in Classical Knowledge in Respiratory Physiology
		10.1	 Respiratory Mechanics
			10.1.1	 Plateau, Peak Inspiratory Pressure and Transpulmonary Pressure
			10.1.2	 Positive End-Expiratory Pressure and Recruitment Maneuvers
			10.1.3	 Auto-PEEP
			10.1.4	 Driving Pressure
			10.1.5	 Tidal Volume
			10.1.6	 Compliance and Functional Residual Capacity
			10.1.7	 Inspiratory to Expiratory Time Ratio
			10.1.8	 Stress and Strain
		10.2	 Gas Exchange
		10.3	 Ventilation-Perfusion-Matching
		10.4	 Ventilation
		10.5	 Perfusion
		10.6	 Considerations for Non-tubed Procedures
		References
	11: Non-intubated Video-Assisted Surgery: A Critical Review
		11.1	 Introduction
		11.2	 History of Non-intubated Thoracoscopy
		11.3	 Pathophysiology of Breathing with an Open Pneumothorax
			11.3.1	 Decrease in Lung Volumes and Lung Function
			11.3.2	 Hemodynamic Changes of an Open Pneumothorax with Breathing
		11.4	 Patient Selection for Non-intubated Video-Assisted Thoracic Surgery
			11.4.1	 Indications
			11.4.2	 Contraindications to Non-intubated VATS (Table 11.1)
		11.5	 Anesthesia for Non-intubated Video-Assisted Thoracic Surgery
			11.5.1	 Regional Anesthesia
			11.5.2	 Sedation for NI-VATS
			11.5.3	 Airway and Oxygenation During NI-VATS
			11.5.4	 Monitoring During NI-VATS
		11.6	 Benefits of NI-VATS
		11.7	 Safety of NI-VATS
		11.8	 Conclusions
		References
	12: Changes in Ventilation Strategies During Thoracic Surgery: Do We Have to Focus “Only” in Oxygenation?
		12.1	 Introduction
		12.2	 “Protective Ventilation”
			12.2.1	 Tidal Volume (VT)
			12.2.2	 Lung Recruitment Manoeuvres
			12.2.3	 Positive End-Expiratory Pressure (PEEP)
		12.3	 Ventilatory Modes
		12.4	 CPAP to the Nondependent Lung
		12.5	 Inhalational vs IV Anaesthetics
		12.6	 Conclusion
		References
Part III: Perioperative Medicine: Analgesia, Applied Pharmacology, Hemodynamic Control and Infections
	13: Change in “Gold Standard” of Thoracic Epidural in Thoracic Surgery
		13.1	 Introduction
		13.2	 Thoracic Surgery: From Thoracotomy to Video-Assisted Thoracoscopic and Robotic Surgery—Toward Minimally Invasive Procedures—Fast-Track Surgery and Eras
		13.3	 Thoracic Surgery and Analgesia: Together into the Future
			13.3.1	 Thoracic Epidural Analgesia
			13.3.2	 Intercostal Nerve Block
			13.3.3	 Interpleural Nerve Block
			13.3.4	 Paravertebral Nerve Block
			13.3.5	 Fascial Blocks on the Thoracic Wall
		13.4	 Gold Standard in Thoracic Surgery
		References
	14: Are There New Evidences on the Use of Neuromuscular Blocking Agents and Reversal Drugs in Thoracic Surgery?
		14.1	 Introduction
		14.2	 Aspects of Interest for the Clinician About the Neurobiology of the Neuromuscular Junction
		14.3	 Some Considerations on NMBA Pharmacology
		14.4	 Characteristics of Patients Under Oncologic Thoracic Surgery Related to Muscle Function
		14.5	 Muscle Relaxation Requirements During Thoracic and Esophageal Surgical Procedures
		14.6	 Recovery from Neuromuscular Blockade After Thoracic Surgery
		14.7	 Day Case Thoracic Surgical Procedures
		14.8	 Thoracic Procedures in Patients with Neuromuscular Diseases and Rare Diseases
		14.9	 Neuromuscular Blockade and Invasive Bronchology (Bronchoscopy and Echobronchoscopy-EBUS)
		14.10	 Postoperative Pulmonary Complications: The Role of (Neglected) Residual Neuromuscular Blockade
		14.11	 Conclusions
		References
	15: Are Anticoagulants and Antiplatelet Agents Important in Thoracic Surgery?
		15.1	 Are Anticoagulants and Antiplatelet Agents Important in Thoracic Surgery?
		15.2	 Is It Important the Bleeding and Thrombotic Risk Assessment?
			15.2.1	 Bleeding Risk in Thoracic Surgery
			15.2.2	 Thrombotic Risk
		15.3	 How to Manage Anticoagulation in Patients Scheduled for Thoracic Surgery?
			15.3.1	 Is It Necessary to Withdraw the Anticoagulant?
				15.3.1.1	 Vitamin K Antagonists
				15.3.1.2	 Direct Oral Anticoagulants
			15.3.2	 What About Anticoagulation After Surgery?
		15.4	 How to Manage Antiplatelet Drugs in Patients Scheduled for Thoracic Surgery?
			15.4.1	 Which Are Main Recommendations for Patients Scheduled for Thoracic Surgery?
				15.4.1.1	 Aspirin
			15.4.2	 Clopidogrel and Prasugrel
		15.5	 Is It Suitable the Thromboprophylaxis in Thoracic Surgery?
			15.5.1	 Which Methods for Thromboprophylaxis Are Available?
			15.5.2	 Rationale for Thromboprophylaxis in Thoracic Surgery
			15.5.3	 Which Recommendations for Thromboprophylaxis in Thoracic Surgery?
			15.5.4	 Thromboprophylaxis in the Perioperative Period: Implications for the Anaesthesiologist
		References
	16: Prevention and Treatment of Infections
		16.1	 Introduction
		16.2	 Surgical Site Infections
		16.3	 Prevention of Surgical Site Infections on Thoracic Surgery
			16.3.1	 CDC: OMS Recommendations
			16.3.2	 Multimodal Strategy in Thoracic Surgery: Enhanced Recovery Thoracic Surgery
		16.4	 Antibiotic Prophylaxis in Thoracic surgery
		16.5	 Early Infection Diagnosis
			16.5.1	 Rapid Microbiological Diagnostic Tests
			16.5.2	 Exhaled Breath Biomarkers
			16.5.3	 Blood Biomarkers
			16.5.4	 Immune Dysregulation
			16.5.5	 Endothelium and Infection
		16.6	 Nosocomial Infection
			16.6.1	 Pneumonia
				16.6.1.1	 Non-antibiotic Treatment of Infection
			16.6.2	 Empyema
			16.6.3	 Mediastinitis
		References
	17: The Role of Ultrasound (US) in Thoracic Surgery
		17.1	 Introduction
		17.2	 Echocardiography in Thoracic Surgery and Chest Trauma
		17.3	 Perioperative Lung Ultrasound (PoLUS)
			17.3.1	 Equipment
			17.3.2	 Recommended Scanning Regions (Fig. 17.2)
			17.3.3	 Terminology: The Lung Ultrasound Alphabet
				17.3.3.1	 BAT-Sign with Identification of the Pleural Line (Fig. 17.3)
				17.3.3.2	 A-lines
				17.3.3.3	 Lung Sliding and Lung Pulse
				17.3.3.4	 M-Mode Signs: The Seashore, Stratosphere Sign and T-Lines (Fig. 17.4)
				17.3.3.5	 The Lung Point
				17.3.3.6	 B-Lines and Lung Rockets
				17.3.3.7	 The Tissue-Like Sign
				17.3.3.8	 Pleural Fluid
			17.3.4	 Clinical Applications
				17.3.4.1	 One-Lung Ventilation and Airway Instrumentation
				17.3.4.2	 Pneumothorax
				17.3.4.3	 Fluid Administration/Lung Edema
				17.3.4.4	 Atelectasis/Lung Expansion
				17.3.4.5	 Pleural Fluid and Thoracentesis
				17.3.4.6	 Diaphragmatic Function
		17.4	 Conclusion
		References
	18: Changes in Classical Monitoring: Hemodynamic Monitoring, New Devices, NIRS, etc.
		18.1	 Hemodynamic Monitoring
			18.1.1	 Invasive Monitoring
				18.1.1.1	 Pulmonary Artery Catheter
				18.1.1.2	 Transpulmonary Thermodilution Methods
			18.1.2	 Minimally Invasive Monitoring
				18.1.2.1	 Non-invasive Monitoring: Bioimpedance and Bioreactance
				18.1.2.2	 Applied Fick’s Principles: Partial CO2 Rebreathing (NICO® System)
				18.1.2.3	 Doppler Techniques
		18.2	 Near-Infrared Spectroscopy (NIRS)
			18.2.1	 NIRS History
			18.2.2	 Principle and Limitations of NIRS
			18.2.3	 Cerebral Autoregulation and NIRS
			18.2.4	 In Assessing Tissue Perfusion with NIRS and Changes in the Presence of Comorbidities
			18.2.5	 Assessment of Anemia-Transfusion Threshold, Cardiac Output, Oxygenation
			18.2.6	 One-Lung Ventilation and NIRS
		References
Part IV: Specific Surgical Situations
	19: Lung Transplantation: Justification for a Paradigm Change
		19.1	 Introduction
		19.2	 Lung Transplant Anaesthesia Mission
			19.2.1	 Preoperative Paradigms
			19.2.2	 Donor Management Paradigms and Ex Vivo Lung Perfusion
			19.2.3	 Intra and Postoperative Paradigms
		19.3	 Ex Vivo Lung Perfusion (EVLP)
		19.4	 Intraoperative Management Strategies to Prevent PGD and Nonpulmonary Complications
			19.4.1	 Trend Away from Clamshell Towards Minimally Invasive LTx (MILT)
			19.4.2	 Role of Cardiopulmonary Bypass (CPB)
			19.4.3	 Management of Pulmonary Hypertension
			19.4.4	 Controlled Reperfusion
			19.4.5	 Hyperoxia and Oxygen Toxicity
			19.4.6	 Antioxidant Treatment
			19.4.7	 Intravenous Fluid Therapy
		19.5	 Protective Ventilation
		19.6	 Novel Mechanisms of Lung Injury: Monocytes and Cytokines
		References
	20: Extracorporeal Life Support (ECMO) in Thoracic Surgery
		20.1	 Introduction
		20.2	 Configuration
			20.2.1	 VV ECMO
			20.2.2	 VA ECMO
		20.3	 Cannulation
			20.3.1	 VV ECMO
				20.3.1.1	 Two Cannula VV ECMO
				20.3.1.2	 Single Cannula VV ECMO
			20.3.2	 VA ECMO
				20.3.2.1	 Central Cannulation (Sternotomy)
				20.3.2.2	 Peripheral Cannulation
		20.4	 ECMO in Thoracic Surgery
			20.4.1	 Airway Surgery
			20.4.2	 Difficult or Impossible One Lung Ventilation (OLV)
			20.4.3	 Mediastinal Masses
			20.4.4	 Advanced Surgical Resections
			20.4.5	 Thoracic Emergencies
			20.4.6	 Lung Transplantation (LTx)
				20.4.6.1	 Bridge to Ltx
				20.4.6.2	 Intraoperative support
				20.4.6.3	 Postoperative Period
			20.4.7	 Acute Respiratory Distress Syndrome (ARDS)
		20.5	 Management
			20.5.1	 Monitoring
			20.5.2	 Anticoagulation
			20.5.3	 Ventilation
			20.5.4	 Hemodynamic
			20.5.5	 Other Monitoring
			20.5.6	 Weaning
		20.6	 Complications
		20.7	 Conclusions
		References
	21: Thoracic Surgery in Patients with Previous Lung Resection
		21.1	 Introduction
		21.2	 Respiratory Mechanics After Lung Resection
		21.3	 Airway Anatomy Changes After Lung Resection
		21.4	 Lung Isolation/Separation in Patients with Previous Lung Resections
		21.5	 Perioperative Mechanical Ventilation in Patients with Previous Lung Resections
		21.6	 Hemodynamic Changes After Lung Resection and Perioperative Hemodynamic Management
		21.7	 Conclusions
		References
	22: Anesthesia for Esophageal Surgery
		22.1	 Conceptual Hypothesis
		22.2	 Types of Esophagectomy
			22.2.1	 Traditional Approaches
			22.2.2	 New Approaches
		22.3	 Preoperative Preparation and Patient Selection for Minimally Invasive and Robotic Esophagectomy
		22.4	 Anesthesia for Minimal Invasive and Robotic Esophagectomy
			22.4.1	 Induction, Maintenance, Ventilation
			22.4.2	 Fluid Management
			22.4.3	 Blood Administration
			22.4.4	 Analgesia
		22.5	 Postoperative Care After Esophagectomy: Enhanced Recovery After Esophagectomy
			22.5.1	 Timing of Extubation and Supplemental Oxygen Therapy
			22.5.2	 Deep Vein Thrombosis Prophylaxis
			22.5.3	 Management of Drainage Tubes
			22.5.4	 Physiotherapy
			22.5.5	 Pain Management
		22.6	 Conclusions
		References
	23: Tracheal and Bronchial Surgery: HJFV
		23.1	 Introduction
		23.2	 Etiology: Post-tracheostomy Tracheal Stenoses Are on the Rise
		23.3	 Does the Surgery of the Large Airways Require Special Equipment?
		23.4	 General Anesthesia: Always Necessary?
		23.5	 Prepping the Patient for Anesthesia: What Information Do We Need?
		23.6	 The Anesthetic Technique Varies by Lesion Site: Optimizing the Anesthetic Steps with the Surgical Moments
			23.6.1	 Upper Tracheal Stenosis (Non-critical Subglottic)
			23.6.2	 Median Tracheal Stenosis
			23.6.3	 The Distal Trachea (Minus the Carina) is Resected Following the Same Ventilation and Surgical Rules Like in the Case of the Other Tracheo-tracheal Anastomosis
			23.6.4	 Carinal Resections with or Without Lung Resection
			23.6.5	 Esotracheal and Esobronchial Fistulas
			23.6.6	 Stenosis of the Large Bronchi: Bronchial Sleeve Resection
		23.7	 Recovery from Anesthesia
		23.8	 High Frequency Jet Ventilation (HFJV)
		23.9	 Conclusions
		References
	24: Pediatric Thoracic Anesthesia
		24.1	 Introduction
		24.2	 Pediatric Anatomy and Physiology
			24.2.1	 Effects of the Lateral Decubitus Position and One Lung Ventilation (OLV) in Children
		24.3	 Preoperative Evaluation
		24.4	 Anesthetic Techniques
			24.4.1	 Flexible Bronchoscopy
			24.4.2	 Rigid Bronchoscopy (RB)
			24.4.3	 Thoracic Surgery
				24.4.3.1	 Preoperative Period
				24.4.3.2	 Intraoperative Period
				24.4.3.3	 Ventilation Techniques
				24.4.3.4	 Sternotomy
				24.4.3.5	 Two Lung Ventilation with Manual Retraction
				24.4.3.6	 Lung Isolation and OLV
					Selective Bronchial Intubation
					Bronchial Blocker
					Univent Tube
					Double Lumen Tube
					Hypoxemia Management During OLV
				24.4.3.7	 Monitoring
				24.4.3.8	 Pain Management
					Regional Modalities
					Intravenous Modalities
		24.5	 Conclusion
		References
	25: Robot-Assisted Thoracic Surgery and Anesthesia
		25.1	 Introduction
		25.2	 Surgical Point of View for Thoracic Robotic Surgery
			25.2.1	 Advantages, Disadvantages, Learning Curves
			25.2.2	 The Robot Assisted Lobectomy
			25.2.3	 The Robot Assisted Segmentectomy
			25.2.4	 The Robot Assisted Thymectomy
			25.2.5	 Summary of Surgical Point of View
		25.3	 Anesthetic Management of RATS
			25.3.1	 Are There Any Differences?
			25.3.2	 Understanding the Surgical Technique and Equipment and Patient Selection
			25.3.3	 Access to the Patient
			25.3.4	 Positioning of the Patient
			25.3.5	 Intraoperative Monitoring, CO2 Insufflation, Fluids
			25.3.6	 Communication
			25.3.7	 Lung Separation Techniques
			25.3.8	 Pain Management
			25.3.9	 Responsibility and Ethical Considerations
		25.4	 Conclusions
		References
	26: Interventional Bronchology
		26.1	 Introduction
		26.2	 Rigid Bronchoscopy
			26.2.1	 Introduction
			26.2.2	 Indications
			26.2.3	 Contraindications
		26.3	 Endoscopic Pneumological Techniques Using Anesthesia
			26.3.1	 Introduction
			26.3.2	 EBUS
			26.3.3	 Endobronchial Laser Surgery
			26.3.4	 Endobronchial Electrosurgery: Coagulation Using Argon Plasma
			26.3.5	 Cryotherapy
			26.3.6	 Cryobiopsy
			26.3.7	 Placement of Endobronchial Prostheses
			26.3.8	 Volume Reduction Techniques and the Treatment of Air Leaks
			26.3.9	 Endoscopic Treatment of Asthma: Bronchial Thermoplasty
		26.4	 Bronchoscopy and Anesthesia
			26.4.1	 Monitoring Anaesthesia in Interventional Bronchology
			26.4.2	 Preoperative Evaluation
			26.4.3	 Monitoring Anaesthesia in Bronchology
		26.5	 Approaches to Anaesthesia with a Rigid Bronchoscope
		26.6	 Ventilation Using Rigid Bronchoscopy
		26.7	 Approaches to Anaesthesia with a Flexible Bronchoscope
		References