Ketamine administration for rigid bronchoscopy in adult: literary review and the operator perception

Abstract

Background and objective: Central airway obstruction (CAO) in adults may be a life‑threatening condition requiring rigid bronchoscopy (RB). This procedure is remarkably demanding and challenging both for the anesthesiologist and the interventional bronchoscopist. The more suitable and comfortable anesthetic management is not clear.

Methods: Some authors reported brief experiences with ketamine administration. We collected the main reports about ketamine usage in adult thoracic endoscopy-both flexible and rigid. Then we briefly reported our methodology describing our total intravenous anesthesia (TIVA) with ketamine usage combined with spontaneous assisted ventilation (SAV) in RB and introducing our initial experience with this procedure. Finally, we draw a picture of our operator's feelings and perceptions.

Key content and findings: There are very few reports about ketamine administration in RB for adult patients. Our ketamine-remifentanil-propofol protocol combined with SAV yielded a very remarkable comfort to the surgeon and anesthesiologist because of the patient's deep stillness and the very infrequent desaturation occurrence.

Conclusions: Operator's comfort during RB is of paramount importance in order to achieve the therapeutic goal and maintain patient's safety. Ketamine-remifentanil-propofol TIVA seems to be safe and feasible for anesthetic management of RB in adult. This drug regimen may be reliable in several possible interventions for malignant and benignant conditions.

Keywords: Ketamine; central airway obstruction (CAO); rigid bronchoscopy (RB).