Airway anatomy for the bronchoscopist: An anesthesia approach

  • Hans Fred García Araque Cardiovascular Anesthesiologist, Anesthesiology and Resuscitation Department, Hospital Militar Central, Bogotá D.C., Colombia
  • Oscar Valencia Orgaz Anesthesiologist, FEA Anesthesiology and Resuscitation Department Hospital 12 de Octubre, Madrid, Spain
  • Ramón López Vicente Anesthesiologist, DESA, FEA Anesthesiology and Resuscitation Department Hospital 12 de Octubre, Madrid, Spain
  • Sergio Esteban Gutiérrez Vidal Medical Student, Universidad Militar Nueva Granada, Bogotá D.C., Colombia
Keywords: Bronchoscopy, Anatomy, Airway management, Anesthesia, Pulmonary medicine

Abstract

Introduction: Knowledge and development of skills in the management of the airway is one of important competencies in the training of the anesthesiologist, "knowledge" and "know how well and fast" are decisive in some critical situations during the anesthetic management. Bronchoscopy is a useful both diagnostic and therapeutic procedure. Knowledge of technique and the anatomy of the airway is the key of bronchoscopy, finding different anatomic variations and classifications of the airway.

Objective: Describe the airway anatomy through diagrams, evaluate anatomic variations and characteristics of procedure.

Methodology: With the keywords "Bronchoscopy" and "Anatomy", "Airway", "Anesthesia" held a non-systematic review databases (PUBMED/MEDLINE, OVID, Science Direct, SciELO).

Results and conclusions: The bronchoscopy is a useful procedure in the surgical level and diagnosis, being used in various procedures. Airway anatomical variations occur in a small percentage of the population. Anatomical classifications are different both anatomic as numerically, but what is important is developing a spatial relation. Bronchoscopy is a technique that goes in parallel development of other advances in biomedical technology, is a procedure whereby the anesthesiologist should be investigated in order to generate better effects in the field of the anesthesiology.

References

1. Lema E, Medina H, González C, Hoyos CE, Tafur LA. Guía para la intubación con fibrobroncoscopio en un Hospital Universitario. Rev Colomb Anestesiol. 2012;40:60-6.

2. Barato EE, Bernal A, Carvajal FB, Giraldo C, Echeverri F, Martínez DA, et al. Consideraciones anestésicas para procedimientos de neumología intervencionista. Rev Colomb Anestesiol. 2011;39:316-28.

3. Klein U, Karzai W, Bloos F, Wohlfarth M, Gottschall R, Fritz H, et al. Role of fiberoptic bronchoscopy in conjunction with the use of double-lumen tubes for thoracic anesthesia. Anesthesiology. 1998;88:346.

4. Desiderio DP, Burt M, Kolver AC, Fischer ME, Reinsel R, Wilson RS. The effects of endobronchial cuff inflation on double-lumen endobronchial tube movement after lateral positioning. J Cardiothorac Vasc Anesth. 1997;11:595-8.

5. Mehta AC, Dweik RA. Controversies in bronchoscopy nasal versus oral insertion of the flexible bronchoscope: Pronasal insertion. J Bronchol. 1996;3:224-8.

6. Colt HG. Is sedation necessary for bronchoscopy? Con sedation. J Bronchol. 1994;1:250-3.

7. Gonzalez R, De-la-Rosa-Ramirez I, Maldonado-Hernandez A, Dominguez-Cherit G. Should patients undergoing a bronchoscopy be sedated? Acta Anaesthesiol Scand. 2003;47:411-5.

8. Mehta AC. Don't lose the forest for the trees: Satisfaction and success in bronchoscopy. Am J Respir Crit Care Med. 2002;166:1306-7.

9. Ayuse T, Hoshino Y, Kurata S, Ayuse T, Schneider H, Kirkness JP, et al. The effect of gender on compensatory neuromuscular response to upper airway obstruction in normal subjects under midazolam general anesthesia. Anesth Analg. 2009;109:1209-18.

10. Shorten GD, Opie NJ, Graziotti P, Morris I, Khangure M. Assessment of upper airway anatomy in awake, sedated and anaesthetised patients using magnetic resonance imaging. Anaesth Intensive Care. 1994;22:165-9.

11. Pearce S. Fiberoptic bronchoscopy: Is sedation necessary? BMJ. 1980;281:79-80.

12. Colt HG, Morris JF. Fiberoptic bronchoscopy without premedication. A retrospective study. Chest. 1990;98:1327-30.

13. Prakash UB, Offord KP, Stubbs SE. Bronchoscopy in North America: The ACCP survey. Chest. 1991;100:1668-75.

14. Reed A. Preparation of the patient for awake flexible bronchoscopy. Chest. 1992;101:244-53.

15. Torres AM. Dexmedetomidina para sedación durante intubación difícil con fibrobroncoscopia. Rev Colomb Anestesiol. 2006;34:55-6.

16. Bergese SD, Khabiri B, Roberts WD, Howie MB, McSweeney TD, Gerhardt MA. Dexmedetomidine for conscious sedation in difficult awake fiberoptic intubation cases. J Clin Anesth. 2007;19:141-4.

17. Stolz D, Chhajed PN, Leuppi JD, Brutsche M, Pflimlin E, Tamm M. Cough suppression during flexible bronchoscopy using combined sedation with midazolam and hydrocodone: A randomized, double-blind, placebo-controlled trial. Thorax. 2004;59:773-6.

18. Vincent BD, Silvestri GA. An update on sedation and analgesia during flexible bronchoscopy. J Bronchol. 2007;14:173-80.

19. Webb AR, Woodhead MA, Dalton HR, Grigg JA, Millard FJ. Topical nasal anesthesia for fiberoptic bronchoscopy: Patients' preference for lignocaine gel. Thorax. 1989;44:674-5.

20. Randell T, Yli-Hankala A, Valli H, Lindgren L. Topical anesthesia of the nasal mucosa for fiberoptic airway endoscopy. Br J Anaesth. 1992;68:164-7.

21. Honeybourne D, Neuman C. An audit of bronchoscopy practice in the United Kingdom: A survey of adherence to national guide lines. Thorax. 1997;52:709-13.

22. Roffe C, Smith MJ, Basran GS. Anticholonergic premedication for fiberoptic bronchoscopy. Monaldi Arch Chest Dis. 1994;49:101-6.

23. Campos JH. Progress in lung separation. Thorac Surg Clin. 2005;75:71-83.

24. Hautmann H, Bauer M, Pfeifer KJ, Huber RM. Flexible bronchoscopy: A safe method for metal stent implantation in bronchial disease. Ann Thorac Surg. 2000;69:398-401.

25. Hautmann H, Gamarra F, Henke M, Diehm S, Huber RM. High frequency jet ventilation in interventional fiberoptic bronchoscopy. Anesth Analg. 2000;90:1436-40.

26. Boyden EA, Clark SL, Danforth CH, Greulich WW, Corner GW. Committee on anatomical nomenclature. Science. 1942;96:116.

27. Jackson CL, Huber JF. Correlated anatomy of the bronchial tree and lungs with a system of nomenclature. Dis Chest. 1943;9:319-26.

28. Yamashita H. Roentgenologic Anatomy of the Lung. 1st ed. Igaku-Shoin: Tokyo; 1978.

29. Isaacs RS, Sykes JM. Anatomy and physiology of the upper airway. Anesthesiol Clin North Am. 2002;20:733-45.

30. Reznik GK. Comparative anatomy, physiology, and function of the upper respiratory tract. Environ Health Perspect. 1990;85:171-6.

31. Pohunek P. Development, structure and function of the upper airways. Paediatr Respir Rev. 2004;5:2-8.

32. Brimabombe JR. Anatomy. 2nd ed. Philadelphia: Elsevier; 2005. p. 73-104.

33. Green GM. Lung defense mechanisms. Med Clin North Am. 1973;57:547-62.

34. Newhouse M, Sanchis J, Bienenstock J. Lung defense mechanisms (first of two parts). N Engl J Med. 1976;295: 990-8.

35. Ovassapian A, Glassenberg R, Randel GI, Klock A, Mesnick PS, Klafta JM. The unexpected difficult airway and lingual tonsil hyperplasia: A case series and a review of the literature. Anesthesiology. 2002;97:124-32.

36. Roberts JT. Functional anatomy of the larynx. Int Anesthesiol Clin. 1990;28:101-5.

37. Petcu LG, Sasaki CT. Laryngeal anatomy and physiology. Clin Chest Med. 1991;12:415-23.

38. Roberts J. Fundamentals of Tracheal Intubation. New York: Grune & Stratton; 1983.

39. Meiteles LZ, Lin PT, Wenk EJ. An anatomic study of the external laryngeal framework with surgical implications. Otolaryngol Head Neck Surg. 1992;106:235-40.

40. Hyde DM, Hamid Q, Irvin CG. Anatomy, pathology, and physiology of the tracheobronchial tree: Emphasis on the distal airways. J Allergy Clin Immunol. 2009;124:S72-7.

41. Boiselle PM. Imaging of the large airways. Clin Chest Med. 2008;29:181-93.

42. Jin-Hee K, Ro YJ, Seong-Won M, Chong-Soo K, Seong-Deok K, Lee JH, et al. Elongation of the trachea during neck extension in children: Implications of the safety of endotracheal tubes. Anesth Analg. 2005;101:974-7.

43. Brodsky JB, Benumof JL, Ehrenworth J. Depth of placement of left double-lumen tubes. Anesth Analg. 1991;73:570-6.

44. Minnich DJ, Mathisen DJ. Anatomy of the trachea, carina and bronchi. ThoracSurg Clin. 2007;17:571-85.

45. Thomas BP, Strother MK, Donnelly EF, Worrell JA. CT virtual endoscopy in the evaluation of large airway disease: Review. AJR Am J Roentgenol. 2009;192:S20-30.

46. Jeffery PK. Remodeling in asthma and chronic obstructive lung disease. Am J Respir Crit Care Med. 2001;164: S28-38.

47. Aysola RS, Hoffman EA, Gierada D, Wenzel S, Cook-Granroth J, Tarsi J, et al. Airway remodeling measured by multidetector CT is increased in severe asthma and correlates with pathology. Chest. 2008;134:1183-91.

48. Seymour AH. The relationship between the diameters of the adult cricoid ring and main tracheobronchial tree: A cadaver study to investigate the basis for double-lumen tube selection. J Cardiothorac Vasc Anesth. 2003;17:299-301.

49. Gonlugur U, Efeoglu T, Kaptanoglu M, Akkurt I. Major anatomical variations of the tracheobronchial tree: Bronchoscopic observation. Anat Sci Int. 2005;80: 111-5.

50. Benumof JL, Partridge BL, Salvatierra C, Keating J. Margin of safety in positioning modern double-lumen endotracheal tubes. Anesthesiology. 1985;67:729.
How to Cite
1.
García Araque HF, Valencia Orgaz O, López Vicente R, Gutiérrez Vidal SE. Airway anatomy for the bronchoscopist: An anesthesia approach. Colomb. J. Anesthesiol. [Internet]. 2014Jul.1 [cited 2021Jun.24];42(3):192-8. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/668

Downloads

Download data is not yet available.
Published
2014-07-01
How to Cite
1.
García Araque HF, Valencia Orgaz O, López Vicente R, Gutiérrez Vidal SE. Airway anatomy for the bronchoscopist: An anesthesia approach. Colomb. J. Anesthesiol. [Internet]. 2014Jul.1 [cited 2021Jun.24];42(3):192-8. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/668
Section
Narrative review

More on this topic