Chaux, MD 

(Pulmonologist)

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• Endobronchial Ultrasound (EBUS) guided biopsies:

  • Minimum size 8.5 ETT. Cannot ventilate around the scope with anything smaller. 

 

• ION robotic navigation guided biopsies

  • Deep paralysis necessary for integrity of nav registration. Any movement will require restarting procedure for re-registration. 

  • 45-60min procedures. 

  • Atelectasis prevention

    • To optimize fidelity of the CT scan navigation 

    • For all patients: FiO2 40%, Vt 400, PEEP 10, rate 10 (easy to remember 40 400, 10 10)

  • Fluoroscopy necessary for live view of biopsy needle coming out of the sheath. 

 

• Cryo cases for ILD lung biopsy

  • Minimum size 9.0 ETT. 

  • LMA for proximal airway lesions. 

    • Our LMAs have two little silicon strips across the orifice in LMA. Cut those out prior to placement so a scope can pass through. 

 

• CryoSpray Ablation with TrueFreeze Cryospray for central airway obstruction

  • Concern for rapid expansion of cold air causing pneumothorax. 

  • Must communicate with Dr. Chaux and be prepared to disconnect circuit and deflate ETT cuff during cryo portions. LMA just needs to be disconnected, not deflated. 

 

• Rigid Bronchoscopy

  • Jet ventilation ideal.

  • Induce patient and hand off airway to Dr. Chaux.  Jet ventilator can be hooked up to rigid scope. 

  • TIVA since it’s jet vent. 

  • Deep paralysis throughout case to prevent injury from bucking on scope.

  • If using laser or cautery, decrease FiO2 <40% to prevent fires. 

 

• In general try to limit inhaled volatile anesthetic. Higher chances of it leaking out or not delivering to patient predictably given the procedures. 

• Dr. Chaux has no preference on our use of benzos or narcotics but wants us to be using propofol for the bulk of the anesthetic. 

• High risk patients (i.e. highly vascular airway tumors) will be risk stratified and can be sent to the main OR based. Please discuss your concerns with Dr. Chaux.