Why different types of anesthesia may be used for the same procedure

When I was diagnosed in January 2017 with idiopathic pulmonary fibrosis (IPF), I had gone under anesthesia only twice in my 59 years. Since my diagnosis, and especially following my bilateral lung transplant in 2021, I’ve required different types of anesthesia for more than 30 procedures. Most of those were bronchoscopies, with several double heart catheterizations thrown into the mix.

During a recent discussion with fellow IPF patients, I learned that our experiences with anesthesia during bronchoscopies varied. Some patients were under general anesthesia while others were under twilight sedation.

What’s the difference? Why do our experiences vary?

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Understanding the differences

The patient’s comfort is a primary concern in any case where anesthetic drugs are administered. I asked Radhika Garg, director of anesthesiology for the interventional pulmonology department at Inova Fairfax Hospital in Virginia, about the use of anesthesia during a bronchoscopy. I’ll tell you that I didn’t randomly select Garg from a list. She’s administered anesthetics during all but two of my bronchoscopies.

When I asked Garg to help me understand the difference between twilight and general anesthesia, she shared the following:

“Twilight anesthesia for bronchoscopy is typically achieved with a combination of local anesthesia (lidocaine sprayed to the back of the throat and onto the vocal cords) and intravenous sedatives, whereas general anesthesia involves administering intravenous propofol or inhaled anesthetic gases along with the insertion of an airway device which provides the pulmonologist with direct access into the airway while allowing the anesthesiologist to ventilate the patient with oxygen throughout the procedure.”

My experience

During the double heart catheterizations, I was under twilight anesthesia, which meant I could hear everything going on around me. I could see the people in the operating room and the monitors they used to conduct the procedure. I didn’t feel any pain or discomfort, other than occasional pressure at the catheter entry point. I recall being fascinated watching the tube move toward my heart.

My experience with anesthesia during a bronchoscopy was completely different. With Garg, the process has been consistent each time. An IV is inserted in my arm, an oxygen mask is placed over my mouth and nose, and I’m asked to take deep breaths. After several of those breaths, I can hear Garg tell me I may feel the medicine as it passes thru the IV line. Within seconds of feeling its sting, the next thing I’m aware of is a nurse asking me questions as I begin to wake up.

Unlike my experience with twilight sedation, I have no recollection of any part of the procedures that involved general anesthesia. That’s been true whether it’s a flexible bronchoscopy, rigid bronchoscopy, or screening colonoscopy. I’ve only had one rigid bronchoscopy, in which doctors placed a stent in my left bronchial stem. While my jaw was sore following the procedure, I didn’t recall any of it.

There’s always more than one way

I always learn something new from others on the IPF or transplant journey, and that holds true regarding anesthesia during bronchoscopies. While there are certainly similarities and differences, each of our experiences is unique. Based on the limited number of people I’ve talked with, the type of anesthesia used during a bronchoscopy seems to vary depending on the transplant center or medical facility.

There’s nothing wrong with inquiring about the options — not just for anesthesia during bronchoscopies, but for any procedure or therapy. Sharing this kind of valuable information is how I can make every breath count.

Note: Pulmonary Fibrosis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Pulmonary Fibrosis News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to pulmonary fibrosis.