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Background <p>Robotic-assisted bronchoscopy (RAB) relies on stable intrathoracic geometry during cone-beam CT (CBCT) acquisition to ensure accurate navigation and lesion targeting. However, anesthesia-induced atelectasis develops rapidly after induction and can distort airway anatomy, critically impacting the stable intrathoracic geometry required for accurate RAB navigation and lesion targeting. This study evaluated an standardized anesthetic and ventilation protocol designed to prevent atelectasis and maintain physiologic stability during RAB.</p> Methods <p>This single-center retrospective observational study included 20 adult patients who underwent RAB between August and November 2025. All patients received an standardized anesthetic and ventilation protocol integrating a balanced strategy of preoxygenation, ventilation, and hemodynamic management tailored for RAB. The primary outcomes were radiologic atelectasis on intraprocedural CBCT and intraoperative stability. Secondary outcomes included ventilatory mechanics, apnea performance, hemodynamic trends, and procedure-related adverse events.</p> Results <p>Among the 17 patients who underwent intraprocedural CBCT, no radiologic atelectasis was observed (0/17, 0%). No disruptive patient movements occurred in the entire cohort (0/20, 0%). The mean tidal volume was 9.0 ± 0.5 mL/kg ideal body weight and the mean PEEP was 12.2 ± 0.7 cmH₂O. Breath-hold maneuvers supported prolonged apnea (mean 123.6&#xa0;s) with preserved oxygenation. 30% of the patients required rescue vasopressors, but no episodes of refractory hypotension occurred. Procedure-related complications included pneumothorax requiring chest drainage in two patients and minor airway bleeding in one patient, with no serious anesthesia-related events.</p> Conclusions <p>A structured anesthetic and ventilation protocol emphasizing low-to-moderate FiO₂, moderate tidal volume, elevated PEEP, and anticipatory hemodynamic management was associated with the prevention of anesthesia-induced atelectasis while maintaining physiologic stability during RAB. These findings support the potential role of anesthesia in maintaining imaging fidelity for advanced bronchoscopic procedures and provide a physiology-based framework that may guide anesthetic practice for RAB and other image-dependent thoracic interventions.</p>

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Standardized anesthetic and ventilation protocol to prevent atelectasis during robotic-assisted bronchoscopy: retrospective observational study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月6日

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  • Jaehun Lee,
  • Heejung Choi,
  • Geal Hong Hwang,
  • Ju Yeon Park

摘要

Background

Robotic-assisted bronchoscopy (RAB) relies on stable intrathoracic geometry during cone-beam CT (CBCT) acquisition to ensure accurate navigation and lesion targeting. However, anesthesia-induced atelectasis develops rapidly after induction and can distort airway anatomy, critically impacting the stable intrathoracic geometry required for accurate RAB navigation and lesion targeting. This study evaluated an standardized anesthetic and ventilation protocol designed to prevent atelectasis and maintain physiologic stability during RAB.

Methods

This single-center retrospective observational study included 20 adult patients who underwent RAB between August and November 2025. All patients received an standardized anesthetic and ventilation protocol integrating a balanced strategy of preoxygenation, ventilation, and hemodynamic management tailored for RAB. The primary outcomes were radiologic atelectasis on intraprocedural CBCT and intraoperative stability. Secondary outcomes included ventilatory mechanics, apnea performance, hemodynamic trends, and procedure-related adverse events.

Results

Among the 17 patients who underwent intraprocedural CBCT, no radiologic atelectasis was observed (0/17, 0%). No disruptive patient movements occurred in the entire cohort (0/20, 0%). The mean tidal volume was 9.0 ± 0.5 mL/kg ideal body weight and the mean PEEP was 12.2 ± 0.7 cmH₂O. Breath-hold maneuvers supported prolonged apnea (mean 123.6 s) with preserved oxygenation. 30% of the patients required rescue vasopressors, but no episodes of refractory hypotension occurred. Procedure-related complications included pneumothorax requiring chest drainage in two patients and minor airway bleeding in one patient, with no serious anesthesia-related events.

Conclusions

A structured anesthetic and ventilation protocol emphasizing low-to-moderate FiO₂, moderate tidal volume, elevated PEEP, and anticipatory hemodynamic management was associated with the prevention of anesthesia-induced atelectasis while maintaining physiologic stability during RAB. These findings support the potential role of anesthesia in maintaining imaging fidelity for advanced bronchoscopic procedures and provide a physiology-based framework that may guide anesthetic practice for RAB and other image-dependent thoracic interventions.