Abstract：
Pleuroscopy, also known as medical thoracoscopy or local anesthesia thoracoscopy, is a commonly utilized procedure in the growing field of interventional pulmonology and considered a required procedure as part of the interventional pulmonology fellowship curriculum. Pleuroscopy is mainly utilized for parietal pleural biopsies in patients with undiagnosed pleural effusions, with a comparable diagnostic yield to video-assisted thoracoscopy (VATS) (>92%). Pleuroscopy is also performed for talc insufflation for pleurodesis, indwelling pleural catheter insertion, and rarely for decortication in patients with stage 2 empyema. Though these procedures can be done under local anesthesia with moderate sedation, an increasing number of cases are being performed with the presence of the anesthesiologist providing monitored anesthesia care (MAC). Given that a significant number of patients undergoing pleuroscopy will have significant co-morbidities, proceduralists and anesthesiologists must be prepared to manage these cases in a non-OR setup. In this article, we discuss some of the technical aspects of pleuroscopy, and highlight the peri-operative considerations for proceduralists and anesthesiologists in managing these patients including the role of ultrashort sedatives and intraoperative procedural and anesthetic considerations. We also discuss the upcoming adjunctive role of local and regional anesthesia techniques in management of these patients. In addition, we summarize the current data regarding various regional anesthesia techniques and discuss avenues for further research.
摘要：
胸膜镜检查,也称为医用胸腔镜或局部麻醉胸腔镜，是介入肺病学不断发展的领域中常用的程序，并且被认为是介入肺病学研究金课程的一部分。胸膜镜检查主要用于未确诊的胸腔积液患者的顶叶胸膜活检，具有与电视辅助胸腔镜（VATS）相当的诊断率（>92％）。胸膜镜检查也用于滑石粉吹入胸膜固定术，留置胸膜导管插入，很少用于2期脓胸患者的剥皮。虽然这些手术可以在局部麻醉和适度镇静下进行，越来越多的病例在麻醉医师在场的情况下进行监测麻醉护理(MAC).鉴于大量接受胸腔镜检查的患者将有明显的合并症，手术医生和麻醉师必须准备好在非OR设置中处理这些病例。在这篇文章中,我们讨论了胸膜镜检查的一些技术方面，并强调了手术医师和麻醉师在管理这些患者时的围手术期注意事项，包括超短镇静剂的作用以及术中程序和麻醉注意事项。我们还讨论了局部和区域麻醉技术在这些患者管理中的辅助作用。此外,我们总结了有关各种区域麻醉技术的现有数据，并讨论了进一步研究的途径。
