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Our study emphasizes (1) the importance of the preanesthetic examination of surgical patients, to identify those in whom conventional intubation would likely be problematic, and (2) the need to have fiberoptic bronchoscopes and an anesthesiologist or bronchoscopist skilled in their use available in operating suites and intensive care units.
However, this technique requires a skilled bronchoscopist and high-quality equipment, while minimum ventilation with a portable ventilator is easy to operate and more usable.
The preliminary diagnosis of malignancy with a differential diagnosis of metastatic melanoma versus metastatic adenocarcinoma was communicated to the bronchoscopist, and EBUS-guided FNA procedure was concluded; the paratracheal lymph node was not sampled.
While EBUS is performed, the bronchoscopist simultaneously visualizes the ultrasonic and bronchoscopic views on display.
This concern often tempers the desire on the part of the bronchoscopist for obtaining biopsies.
Although pneumonectomy specimens allow assessment of tumor involvement of a main bronchus, determining the distance to the carina, which is necessary to accurately assign a T category for centrally located tumors, typically requires consultation with the surgeon, bronchoscopist, or radiologist.
Two new techniques, electromagnetic navigation bronchoscopy (44,45) and virtual bronchoscopic navigation, (43) allow the bronchoscopist to reach virtually any lung nodule greater than about 2 cm.