Endoscopic lung volume reduction surgery: Anesthetic challenges

Severe chronic obstructive pulmonary disease (COPD) with emphysema is a progressive, debilitating disease. Medical management of this condition can prevent exacerbations but doesn't often reverse the progressive nature of the disease. Endoscopic Lung Volume Reduction (ELVR) is a non-invasive procedure that offers improvement of pulmonary function and quality of life. Most often accomplished by delivery of Endobronchial Valve, ELVR is conducted via fiberoptic bronchoscope, often in a remote location such as an endoscopy suite. Similar to other broncoscopy procedures, ELVR can be completed under GA or MAC anesthesia. Patient factors, such as poor respiratory function and risk of bronchospasm and COPD exacerbation must be considered when making an anesthetic plan. The risk prolonged mechanical ventilation must be weighed against the benefit of controlling mechanical ventilation and creating ideal procedure conditions. Pneumothorax, hemoptysis, and COPD exacerbation are relatively common complications. Valve migration is a rare but devastating complication. Patients require vigilant monitoring in the postoperative period including chest x-ray for any change in clinical status during the entire first week after the procedure. This chapter reviews specifics of ELVR procedure, anesthetic considerations, and common complications.